\DENOIDS 

[INDRED PERILS 
; ; ; ' ; ) '. LIFE 



i ' " ; • : J..D. 




Class 1 

Book 

Copyrights 



COPYRIGHT DEPOSIT. 



ADENOIDS 

AND KINDRED PERILS OF 
SCHOOL LIFE 



ADENOIDS 

AND KINDEED PERILS OF 
SCHOOL LIFE 



pS BY 

D. T. ATKINSON, M.D. 

Editor Eye, Ear, Nose and Throat Department, Texas 
Medical News. Oculist and Aurist to Fowler Or- 
phan Home, Virginia Johnson Home, The 
Monastery of Our Lady, (Sisters of the 
Good Shepherd ) . Member of the 
Staff Saint Paul's Sanitarium, 
Dallas, Texas. 



NEW YORK 

VAIL-BALLOU COMPANY 

PUBLISHERS 



*v 



Copyright 1914 
By D. T. ATKINSON, M.D. 



DEC 29 1914 

©CIA391180 
^0/ 



TO 

AMERICAN SCHOOL CHILDREN 

THIS LITTLE VOLUME IS AFFECTIONATELY DEDICATED 
BY THE ATTTHOB 



PREFACE 

A large part of the subject matter contained 
in this little volume was first contributed as 
"papers" to magazines and lay journals 
throughout the country. The many letters of 
appreciation following their publication and 
the requests for advice upon questions dis- 
cussed from both parents and teachers, have 
been responsible for the author's re-writing 
these papers and placing them with the pub- 
lisher. 

Efforts have been made to eliminate as 
many technical terms as possible, the simplest 
language available having been used. The 
book is presented with a hope that the teacher 
may find in it a solution of some of the every- 
day problems of the schoolroom; that it will 
prove an aid to the perplexed mother, and a 
benefit to many children. 



CONTENTS 

CHAPTEB PAGE 

Introduction 13 

I Adenoids . . 25 

II What are Adenoids? 37 

III The Symptoms of Adenoids ... 55 

IV When is Operation Needed? .... 73 
V Ear Defects 87 

VI Throat Abnormalities 97 

VII Abnormalities of the Eye .... 103 

VIII Common Eye Defects 115 

IX The Care of the Eye 131 

X Bad Postures 137 

XI Nervous Disorders 155 

XII Defective Children 167 

XIII Over Pressure 175 

XIV Effects of Poor Ventilation . . .185 

XV Insufficient Exercise 197 

XVI Tuberculosis 203 

XVII Epidemic Diseases 217 



ILLUSTRATIONS 

PAGE 

Cross Section of Head ........ 39, 

Cross Section of Head Showing the Nasal Ac- 
cessory Sinuses 45 

Deformity of the Chest Often Seen in Children 

with Adenoids 63 ■ 

Typical Facial Expression Resulting from Adenoids 77 v 

Facial Expression of Child Three Months After 

Operation for Adenoids 81 J 

Girl with Strabismus or Crossed Eyes . . . .117 

Wearing Glasses for Correction of Strabismus . .121 

Incorrect Writing Position 145 

Bad Standing Position .149 

Section of Brain Showing Special Centers . . .169 



INTRODUCTION 

In the light of our present knowledge re- 
garding the needs of children at school, we 
almost shudder at the mistakes which were per- 
petrated upon them a few years ago. More 
often than otherwise they were housed in 
rooms improperly heated and as badly venti- 
lated. No thought was given to the impor- 
tance of providing sufficient light from the 
proper source, and desks were not correctly 
arranged to accommodate the size of the child, 
this oversight causing humping shoulders, con- 
tracted chests and strained eyes. 

Hygienic measures for mutual protection 
had not been dreamed of. Diseased children, 
who should have been isolated, became seat- 
mates of healthy ones. The old fashioned 
slate cloth laden with disease-producing or- 

13 



14 INTRODUCTION 

ganisms went the rounds and a drinking cup, 
reeking with germ life, was used by all alike. 

In those "good old days" the dull, stupid 
child, instead of being considered sick mentally 
became the object of corporal punishment or 
occupied the dunce block, the butt of all the 
jokes of his fellow pupils. Children with 
lassitude and headache from eye strain and 
imperfect vision were often punished for back- 
wardness. As a rule they were considered by 
their teachers as automatic little machines and 
were treated as such. 

Gradually a change came about. Some 
thoughtful persons began to advocate that 
children at school had rights and should be 
protected from the many surrounding condi- 
tions which menace their physical welfare and 
retard their intellectual development. Re- 
forms are made slowly. In this movement 
results, though delayed, came eventually, evi- 
denced by the support of a large per cent, of 
people in the movement for better sanitary 
conditions in the schools, closer attention to 



INTRODUCTION 15 

personal hygiene of the pupils and a broader 
understanding generally between pupil and 
teacher. 

The public press has been responsible to 
a great extent for the sympathy this move- 
ment now possesses in the minds of the more 
intelligent people. A number of articles by 
physicians have appeared in the various jour- 
nals of the country during late years which 
have had as their purpose the stimulation of 
the minds of the parents and teachers to the 
necessity of being on the alert for various de- 
fects in children which retard their progress 
physically and mentally. 

That these have served their purpose is in- 
dicated by the fact that conditions which were 
a few years ago almost universally overlooked 
are now readily recognized. 

The awakening of public sentiment through 
the press, has been responsible to a large de- 
gree for the establishment in most of our cities 
of medical inspection of schools. This was the 
first decisive step in the movement for the bet- 



16 INTRODUCTION 

terment of prophylactic and hygienic condi- 
tions in the schoolroom. These first school in- 
spectors were confronted with conditions 
which to us at present seem appalling. In 
some districts of New York twenty-five per 
cent, of the pupils were found to have tra- 
choma, a disastrous and infectious eye dis- 
ease. These were carefully excluded from 
the schools until they were cured. Children 
with tuberculosis in advanced stages were oc- 
cupying desks and using the books and slate 
cloths of healthy children. The schoolrooms 
were found to be prolific sources of infectious 
skin diseases the spread of which no effort had 
been made to control. 

The school inspector had an unpleasant duty 
to perform in setting right, to the best of his 
ability, the pernicious conditions which he 
found and this duty in the majority of cases 
he performed bravely, often in the face of con- 
demnation of parents and severe criticism from 
the public generally. 

In modern inspection the school children's 



INTRODUCTION 17 

hearing is examined in a routine way. The 
little pupil who lacks interest in his studies and 
makes repeated mistakes, the child who is daily- 
laughed at by his fellow pupils and, because 
of this chaffing becomes sullen and lacks confi- 
dence in himself, is often found upon exam- 
ination of his hearing to be deaf. Is it any 
wonder then, that he appears dull of intellect 
and fails to keep up with other children of his 
age? Is it any wonder that the jokes at his 
expense drive him to attacks of despondent 
insubordination? A recognition of this child's 
defect changes things generally. He is some- 
times benefited by medical treatment. If 
this is not possible the teacher should give him 
more individual attention or, as is the case in 
the larger cities, he should be put in a class of 
children equally unfortunate where special 
pains in distinct articulation are taken by the 
teacher. 

Better ventilation, better lights, seats to ac- 
commodate the size of the pupils, with desks 
properly placed to prevent contraction of 



18 INTRODUCTION 

chests and stooping of shoulders, have come 
with the advent of the school examiner, and 
under his regime dirty slate cloths have dis- 
appeared, as have the saliva-besmeared, sec- 
ond-hand books, the interchange of lunches 
and half-eaten fruits, and a campaign of 
education in behalf of hygiene, personal clean- 
liness and health has been originated. 

The medical inspector filled an important 
place in a great movement, but in the larger 
cities it remained for that genius of sympathy, 
tenderness and thoughtful consideration — 
the graduate nurse — to establish conditions 
which are apparently as near perfect as they 
can be made. This great climax in a great 
work came only in 1907. The school nurse 
idea was originated by Miss Rodgers, a nurse 
in New York City. As an experiment she 
took the schools of a ward for six months. 
Her work there was so successful that a corps 
of assistants were employed within a year. 

These nurses were specially selected. They 
were women with all nature's endowments of 



INTRODUCTION 19 

higher and finer feminine feeling, broad- 
minded women who were familiar with social 
problems, their training specially fitting them 
with the sympathy and interest in child 
life necessary to make the movement a suc- 
cessful one. Their success may be estimated 
by the fact that nearly all large cities now em- 
ploy a corps of school nurses. In Chicago 
alone there are nearly forty nurses in the 
schools, though the movement there is very 
young. Several small cities like Pueblo, 
Colo., Berkeley, Cal., and Galesburg, 111., 
now employ nurses in the schools. 

There are many points in favor of the school 
nurse system. For one thing the nurse in the 
schoolroom is on the alert for infectious condi- 
tions which may become epidemic. During 
the first year in New York one of Miss Rodg- 
er's assistants in a ward school discovered and 
immediately had isolated a case of scarlet 
fever. An epidemic with a probable neces- 
sity of closing the school was thus averted. 
Minor infectious conditions are isolated and 



SO INTRODUCTION 

treated under the supervision of the medical 
inspector instead of sending the children home, 
as was formerly done, where they would be 
deprived of the advantages of the class room 
besides having their condition neglected until 
the following year, when they would be sent to 
school again only to have the exclusion 
process repeated. It was found that many 
children had been kept from school for years 
because of some simple skin disease or like 
condition which would have responded readily 
to treatment. 

In many of these cases nurses have found 
it necessary to visit the homes of the children 
in order to instruct the parents and elicit their 
cooperation in preventing re-infection from 
the original sources. When a child has been 
sent home from school because of its having 
contracted some of the acute infectious dis- 
eases of childhood, such as scarlet fever, the 
nurse calls upon the family and instructs the 
mother not to allow his return until he has 
"peeled off." 



INTRODUCTION 81 

Should he be sent back during this period 
the whole school is apt to be infected. The 
mother is taught that while one child has the 
mumps, for instance, the other children of 
the household should not go to school. Since 
the institution of the school nurse there has 
been a general reduction of school epidemics, 
and as the process of education goes on there 
is hope that they may be eliminated entirely. 

Many children have been infected in schools 
with tuberculosis and specific diseases by using 
common drinking cups. Where the school 
nurse has gone the common drinking cup has 
been relegated and the individual cup system 
installed. The good that this movement alone 
has done can scarcely be estimated. 

It is the nurses' duty to be on the alert for 
errors of refraction and eye strain in children, 
as well as for a multitude of eye disorders 
which retard the pupils' progress. Children 
with adenoids are taken to their parents and 
the importance of having the growths removed 
is impressed upon them. They are made to 



22 INTRODUCTION 

understand the disastrous results upon the 
physical being and mentality of the child when 
the condition is not alleviated. In the ma- 
jority of cases the parents are taught to un- 
derstand the circumstances and in these cases 
neglect and procrastination is the exception 
rather than the rule. 



Chapter I 
ADENOIDS 



ADENOIDS AND KINDRED 
PERILS 

Chapter I 
ADENOIDS 

NOT many years ago after the first op- 
eration for appendicitis had been success- 
fully performed, the press heralded to the 
world that a new disease and its cure had been 
discovered. A little later the public, after 
reading an account of an operation for ade- 
noids upon the young king of Spain, asked 
if science was not about to burst the already 
swollen list of diseases by adding new ones. 
The sage who said, "There is nothing new 
under the sun," gave us an adage which is 
nowhere more applicable than in the field of 
pathology. Many diseases, so new a few 
years ago, are now known by the medical pro- 

25 



26 ADENOIDS AND KINDRED PERILS 

f ession and the public to be as old as humanity 
itself. Appendicitis has been laying its vic- 
tims in the grave for thousands of years and 
adenoids have left their baneful symptoms 
among the people of every time and clime. 

The term adenoids applies to an enlarge- 
ment of the third tonsil which lies back of the 
soft palate just high enough to be hidden from 
view. The swelling of this tonsil closes the 
avenue through which normal nasal breathing 
is carried on with the result that mouth breath- 
ing is resorted to. 

That mouth breathing caused by adenoids 
is not a recently acquired condition is proven 
by mention having been made of it in the liter- 
ature of all countries. For centuries it has 
been noticed that mouth breathers have been 
below the standard in intelligence. More than 
two thousand years ago Hippocrates, the 
father of medicine, in a manuscript written 
for his followers said, "Open-mouthed youths 
are sluggards/' and numerous writers in later 
ages have referred to this supposed habit as 



ADENOIDS n 

a cause of mental inferiority. In remote 
periods of human history the defects of the 
mouth-breather have been cut in marble by the 
truthful hand of the sculptor, and several 
Roman and Greek statues, to be seen in the 
British Museum and elsewhere, give us unmis- 
takable evidence of the existence of adenoids 
as far back as Roman and Greek art goes. 
Many instances of mouth breathing are shown 
in later art. 

The famous English throat surgeon, Gary 
Simpson, calls attention to the numerous like- 
nesses of the great sculptor, Canova, of the 
early part of the last century, which represents 
him with open mouth and dull stolid look, and 
he produces evidence that he was deaf and 
melancholy. 

It is a matter of wonder to many that the 
cause of this condition could have so long es- 
caped notice, but a brief sketch of the history 
of medicine and surgery will call to our atten- 
tion the fact that nearly all of its important 
discoveries and achievements have been made 



28 ADENOIDS AND KINDRED PERILS 

within the last century. Few persons are 
aware how little was known of anatomy and 
medicine prior to that time. As an illustra- 
tion, the brain is not mentioned in any an- 
cient literature. The heart was thought to be 
the seat of affection and the warm "spirits of 
air" were sent to the various parts of the body 
through the arteries, hence their name which 
means "carriers of air." This mistake was be- 
lieved sufficiently late to be incorporated into 
the English language, and as a result we have 
the phrases, "whole-hearted," "sick at heart," 
etc. 

In Shakespeare's time, the nerves were 
thought to be tendons which gave strength to 
the body. Dr. Crooke, anatomist and phys- 
iologist, physician to his majesty, James I, 
gave the world the following bit of wisdom: 
"The immediate substance of the haires is a 
sooty, thicke and earthy vapour, which in the 
time of the third concoction is elevated by the 
strengthe and action of the naturall heate." 

Lord Bacon held that the heart was not dis- 



ADENOIDS 29 

tended by blood, but by contained spirits 
which caused it to beat. 

The humane treatment of the insane is of 
most recent origin. Not many years ago the 
insane were considered to be loathsome and re- 
pulsive creatures, whose bodies had been taken 
possession of by unclean spirits following some 
sin of their own or their ancestors, and the 
only hope of relief lay in flogging the poor 
victim with the idea of making his person such 
an uncomfortable abode for the visitor that it 
would retire. 

It is recorded in England that Sir Thomas 
More, one of the greatest humanitarians of 
his age, often ordered the public flogging of 
lunatics, and we can not forget that, even on 
this side of the Atlantic, burning of witches 
was practiced in extreme cases when the 
demons refused to vacate the bodies of de- 
mented persons. 

The first operation, under a general an- 
aesthetic, was performed a little over sixty 
years ago, in the dome of the Massachusetts 



30 ADENOIDS AND KINDRED PERILS 

General Hospital, which institution is still in 
use. Previous to that time the patient to be 
operated upon was securely bound to the table 
and the operation proceeded with little atten- 
tion to his groans and screams. 

The "germ theory" is almost of yesterday, 
and the surgeon now performs, with all safety, 
operations which without the knowledge of 
germ life would mean certain death to his sub- 
ject. 

The microscope has opened up a new knowl- 
edge of the minuter structures of the body 
and has shown the ' 'healthy pus" of the older 
surgeons to be a most potent destroyer of life. 
Animal serums have taken the place of the ex- 
pectant treatment of former days, reducing 
the mortality in some diseases and almost 
abolishing it in others. 

In this age medicine and surgery rest upon 
a sound and scientific basis. Surgical opera- 
tions are robbed of their horrors and are per- 
formed with the subject in dreamless sleep. 
The parched and burning thirst of the patient 



ADENOIDS 31 

delirious with fever may now be moistened 
without fear of producing immediate death. 
The inhumane treatment of the insane is but 
a horrible memory and a foolish old woman 
or a hysterical girl no longer is burned as a 
witch. Not the least among the many vic- 
tories that have been won for science is the dis- 
covery that the unfortunate and distressing 
symptoms attending adenoid growths may be 
relieved by one of the simplest, safest and most 
efficient of all surgical operations. 

Though the mental inferiority of mouth- 
breathers has been recognized for ages, we 
have known only since 1868 that breathing 
through the mouth is not due to habit, but is 
the direct result of disease. The honor of hav- 
ing discovered the true cause of this condition, 
and devising a means of relieving it, is due to 
a Danish physician by the name of Meyer. 
He noticed that children who breathed 
through their mouths by day snored at night. 
After studying a number of these children, he 
found that they were dull, took poorly to their 



32 ADENOIDS AND KINDRED PERILS 

books and did not have an average interest in 
the childish sports of their playmates. He 
observed that they had a thick nasal speech, 
frequently had discharging ears and deafness 
and were often melancholy and stupid. In his 
writings of this time he described them as be- 
ing listless, backward and inferior. 

After months of patient study, this acute 
observer found that the cause of the mouth 
breathing was a spongy growth in the back 
part of the nose which he termed adenoids. 
With rude instruments of his own construc- 
tion he operated upon and relieved a number 
of his worst cases. Soon afterwards he re- 
ported his results to a society of surgeons in 
Copenhagen. His fame spread rapidly and 
in a few years his operation was being prac- 
ticed to some extent at least in every civilized 
country of the world. 

The adenoid operation, though performed 
by a limited number of surgeons in different 
parts of the world, did not come into general 
use until a few years ago. A campaign of 



ADENOIDS 33 

education has been going on in recent years 
and parents as well as physicians are more 
on the alert now than formerly for the detec- 
tion of conditions which interfere with the 
physical welfare of children and retard their 
mental development. Both parents and 
physicians recognize now that mouth breath- 
ing is a condition resulting from disease, that 
it is not a habit and that a child in a normal 
condition will not breathe through its mouth. 
They recognize now as they never did before, 
the cause of mouth breathing in children. 
That cause is adenoids. 

During late years the treatment of all the 
ills resulting from mouth breathing in the 
young, or at least of those who fall into the 
hands of intelligent physicians, has been rev- 
olutionized. The competent physician no 
longer wastes time in trying to subdue the 
symptoms peculiar to mouth-breathing chil- 
dren by internal medication, but strikes at the 
root of the trouble and brings to the little suf- 
ferers speedy relief by removing the cause. 



34 ADENOIDS AND KINDRED PERILS 

Despite the fact, however, that the medical 
profession and a large per cent, of the public 
realize that with this condition are associated 
complications which are grave and disastrous, 
and which are a constant menace to the health 
and welfare of the child, one is confronted al- 
most daily by children whose development, 
both mental and physical, is being arrested by 
this abnormality. 



Chapter II 
WHAT ARE ADENOIDS? 



Chapter II 
WHAT ARE ADENOIDS? 

AS already mentioned, adenoid growths 
consist of an enlargement of "Luschka's 
tonsil/' a structure lying behind the nose. 
The common idea that tonsils exist only on 
each side of the throat is not a correct one 
for they are found in the larynx, on the base 
of the tongue and on the wall behind the nose, 
as well as in the sides of the throat. To those 
who accept the theory that man originated 
from lower forms of life, these tonsils are 
thought of as rudimentary useless organs. 
To others they are still a subject for contro- 
versy. All agree, however, that when en- 
gorged they become a source of great annoy- 
ance and discomfort to their unfortunate pos- 
sessors and that when their enlargement be- 

37 



38 ADENOIDS AND KINDRED PERILS 

comes marked, they give rise to numerous 
baneful symptoms. 

In order that we may trace these symptoms 
to their cause and obtain an understanding of 
the havoc wrought by diseased tonsil tissue 
generally, let us take a brief review of the 
anatomy of the tract through which normal 
breathing takes place. 

When the mouth is opened and carefully 
inspected under a good light a large fleshy 
band will be seen stretching across its upper 
portion just back of the upper jaw. This is 
the soft palate. Attached to it and extend- 
ing downward is a little flabby projection, the 
uvula. The palate and the uvula may be 
spoken of as the line of division between the 
throat behind and the mouth in front. Above 
the palate is the nasal chamber divided by a 
partition, the nasal septum, into two orifices 
or nostrils through which normal breathing 
takes place. 

Back of the partition dividing the nostrils 
is what is generally spoken of as the naso- 




CROSS SECTION OF HEAD 

A represents a large mass of adenoid tissue attached to B the 
back wall of the naso pharynx. 



WHAT ARE ADENOIDS? 41 

pharynx. On the surface of the nasopharynx 
is placed the tonsil tissue which when enlarged 
becomes adenoids. Extending into each 
nostril from the external side are three little 
shelves, the turbinate, which serve a triple pur- 
pose. They increase the area for the distribu- 
tion of the olfactory or smelling nerves, give a 
larger surface for the nasal mucous membrane 
which produces the necessary moisture to be 
taken up by the inspired air, and also provide 
a larger surface for the radiation of heat, 
thereby attending to the proper warming of 
the air before it passes into the lungs. The 
air instead of passing straight through the nose 
as it would if it were not for these little curved 
shelves of bone, is directed from side to side 
and deflected upward and downward, thus be- 
ing brought in contact with a larger surface 
of mucous membrane, receiving more heat and 
moisture therefrom. 

It has been found that when these shelves 
are destroyed by disease the sense of smell is 
either diminished or entirely lost, and the pro- 



42 ADENOIDS AND KINDRED PERILS 

duction of mucus is also greatly interfered 
with. A dry irritated condition of the throat 
results from the absence of this mucus. 

On examining the nostrils of children suf- 
fering from adenoids, the turbinals or shelves 
are almost invariably found to be enlarged, 
sometimes to such an extent that complete oc- 
clusion of the nostrils occurs. The younger 
the child, the less marked is this obstruction. 
In older children this deformity is sometimes 
permanent and the removal of the adenoids 
fails to bring any relief whatever, a potent 
reason for an early operation in all pronounced 
cases. 

Directly above the nose are to be found a 
number of little avenues extending into re- 
cesses in the bony structure of the head. 
These are the accessory nasal sinuses. They 
are generally thought to be functionless, 
though a number of uses have been accorded 
them such as their ability to modify the res- 
onance of the voice, being warming chambers 
for inspired air, etc. They are at times, how- 



WHAT ARE ADENOIDS? 43 

ever, a source of great inconvenience and dis- 
comfort, for the ordinary "cold in the head" 
is usually complicated with an involvement of 
these sinuses, and repeated "colds" often leave 
them chronically diseased. Adenoids, by 
disturbing the normal drainage of mucus from 
these cavities, often give rise to their continu- 
ous congestion, and much of the dull headache 
and stupor to be found in adenoid children may 
be traced to this cause. 

Anyone who has suffered with bad "colds" 
in the head, will recall that mental concentra- 
tion of any kind was difficult or even impos- 
sible during such attacks. How then is a child 
who has perpetually clogged sinuses to make 
mental progress? 

Continuing our exploration further we find 
on the side walls of the nose toward the back, 
two small orifices, the openings for the 
Eustachian tubes, little funnels which lead up 
into the middle ear and serve to drain and 
ventilate them. In the child with adenoids 
these tubes continually invite trouble to the 



44 ADENOIDS AND KINDRED PERILS 

ears, for the swelling occasioned in the mucous 
membrane by the growths impinging on their 
orifices occludes them, so that neither ventila- 
tion nor drainage of the ear can be carried on 
in a normal manner. 

On each side of the throat below the pharynx 
are to be seen two little bands, the pillars, 
which enclose the tonsils. In the normal 
throat, only a small portion of this tonsil can 
be seen as it lies deeply imbedded between 
these folds. In children a slight enlargement 
of the tonsil is so common as to appear to be 
physiologic, but often the enlargement be- 
comes so pronounced that the tonsils lie al- 
most entirely beyond the pillars, practically 
meeting in the middle line, thereby causing 
great obstruction to the breathing. 

These pillars or bands sometimes stretch 
across the tonsils, completely "submerging" 
or covering them. When this occurs the 
bands form a receptacle for food, mucus and 
debris in general, and a chronic inflammation 
of the tonsil tissue ensues. 




CROSS SECTION OF HEAD SHOWING THE NASAL 
ACCESSORY SINUSES 

A frontal sinus. B sphenoidal sinus. C turbinate. D naso- 
pharyngeal wall. E opening of eustachian tube. 



WHAT ARE ADENOIDS? 47 

Behind and below the base of the tongue is 
the trachece or windpipe through which air 
passes to its branches, the bronchi, and thence 
to the lungs. Its upper portion is expanded 
to form the larynw, the sound-producing appa- 
ratus, in which are swung the vocal cords. 
The vocal cords are not cords, as their name 
would indicate, but are folds of elastic tissue 
covered with mucous membrane. They are 
attached in front and behind to cartilages, 
which are drawn apart by the attending mus- 
cles thus tightening the cords. The voice is 
produced by a vibration of these elastic bands. 
In the larynx, as elsewhere where tonsil tissue 
abounds, great disturbance to the voice results 
from its inflammation and enlargement. As- 
sociated with enlargements of the other groups 
of tonsil tissues, is often found involvement of 
this tonsil tissue in the larynx, probably occa- 
sioned by the irritation to the larynx from 
mouth-breathing. 

The familiar Adam's apple is in the front 
part of the larynx. Above the larynx is sus- 



48 ADENOIDS AND KINDRED PERILS 

pended the epiglottis, a little hood which closes 
and protects it during the act of swallowing, 
thus preventing the bolus of food from enter- 
ing the windpipe. Immediately above the 
epiglottis is the base of the tongue, upon which 
are to be found numerous elevated nodules 
composed of tonsil tissue. Inflammation of 
these lingual or tongue tonsils is accompanied 
by a harassing cough and other distressing 
symptoms. When a stone is thrown into a 
placid stream the ripples will be seen to radiate 
into all directions and soon tiny waves are 
breaking upon the shore. 

"Waves" of inflammation may be said to 
travel in the same manner over mucous mem- 
brane, giving rise to disturbances remote from 
the point where they first occurred. In this 
way disorders of the lingual tonsil may be con- 
veyed to the larynx by an extension of the in- 
flammation over the mucous membrane. 

The mucous membrane of the nose and 
throat is a soft delicate structure thickly set 



WHAT ARE ADENOIDS? 49 

with minute blood vessels. It forms the lin- 
ing, so to speak, of the air passages. When 
healthy this membrane is smooth and shiny 
and is of a light red color. In a normal condi- 
tion its surface is bathed with a thin clear fluid, 
but when irritated by "cold," dust or noxious 
gases, this fluid is transformed into a thick, 
ropy and tenacious matter, and becomes a 
favorable medium for the growth of disease 
germs. The starting point of an enlargement 
of the pharyngeal tonsil or adenoids is often 
an infection of this mucus in the nose. An in- 
flammatory swelling of sufficient intensity to 
interfere with the entrance of air through the 
nasal passage is brought about, causing the 
habit of mouth breathing to be formed. The 
inflammatory process in the nose gives origin 
to a similar one in the tonsil tissue directly be- 
hind it and the child becomes a victim of 
adenoids. 

It will be seen, then, that adenoids or en- 
largement of the pharyngeal tonsil may be due 



50 ADENOIDS AND KINDRED PERILS 

to unfavorable climatic conditions. This 
structure has the unhappy faculty of being in- 
terfered with by "colds" very much as other 
tonsil tissue has. In warm climates they are 
not frequently found. It has been noted that 
on the Island of Saporoa (one of the Moluc- 
cas), on the equator where the temperature 
never rises above 75° to 80° and where it is dry 
and mountainous, only five out of seven hun- 
dred and seventeen school children were found 
suffering and not one out of one hundred adults 
examined were affected. On the contrary, in 
Greenland only sixteen out of sixty Esquimau 
children between the ages of six and fourteen 
were found to be free from adenoids. ( Simp- 
son.) Sudden changes in temperature, badly 
ventilated schools and living rooms, exposure 
to wet and cold, and other conditions which 
produce inflammation of the mucous mem- 
brane of the respiratory tract are instrumen- 
tal in causing the largest per cent, of adenoids. 
The imperfect use of the jaws from the prac- 



WHAT ARE ADENOIDS? 51 

tice of feeding children with the bottle and on 
semi-liquid foods, the habit of thumb sucking, 
or what is worse, the sucking of rubber nip- 
ples or "pacifiers" are, no doubt, predispos- 
ing causes in a certain per cent, of cases. 



Chapter III 
THE SYMPTOMS OF ADENOIDS 



Chapter III 
THE SYMPTOMS OF ADENOIDS 

THE symptoms of adenoids are so well 
marked that they will not escape the no- 
tice of any but the most casual observer. The 
change in facial expression is usually very pro- 
nounced. The eyes are often set farther apart 
than in normal children and have a dull, list- 
less appearance. The nostrils may be con- 
tracted. The mouth is held open, the second 
teeth may be irregular and the bearing of the 
child is one of stupidity and inferiority. 
There is, however, a small per cent, of adenoid 
children who do not present, to any marked 
degree, this characteristic dull appearance, yet 
some change in facial expression is nearly al- 
ways present. 

The inability to nurse sometimes seen in in- 

55 



£6 ADENOIDS AND KINDRED PERILS 

fants is caused by a suffocation produced by 
adenoids. In pronounced cases there is a 
regurgitation of the milk through the nose. 
Regurgitation of liquids is sometimes seen in 
adults who have these post-nasal growths, 
especially when the condition is aggravated by 
swelling of the mass from "colds." This 
symptom is due to the adenoids mechanically 
obstructing the soft palate and keeping it from 
closely fitting to the back part of the throat 
and affording normal protection to the nasal 
chambers. 

Children with adenoids very often make a 
peculiar noise while eating which has been 
aptly described by their mothers as "piggified." 
In the more fortunate class of adenoid chil- 
dren a shortening of the upper lip with some 
contraction of the nostrils is all that will be 
noticed. When the growths are large enough 
to prevent free movement of the soft palate 
during speech the voice lacks resonance and 
has a dead muffled sound. The child seems to 
be talking with something held in its mouth. 



THE SYMPTOMS OP ADENOIDS 57 

The nasal sounds are perverted. Words con- 
taining the letters m and n are pronounced with 
difficulty. "Common" sounds like "cobbod"; 
"nose" will become "doze" and "song," "sogg." 
The writer has detected the condition in chil- 
dren whose faces he had not seen by the nasal 
cry and by the peculiar characteristic perver- 
sion of the word "mamma." 

Children with adenoids rest badly at night. 
They breathe through the mouth and snore 
heavily. Their physical discomfort causes 
their sleep to be disturbed by dreams and 
nightmares and it is not unusual for them to 
spend the night in tossing about in bed. They 
awaken in the morning unrested and remain 
tired and peevish during the day. At school 
they are backward, absent-minded and forget- 
ful. There is often an inability to fix the at- 
tention, and as a rule they make poor grades 
in their classes. 

Nearly every observant teacher can now 
pick out these children in the school room, 
guided only by their general appearance and 



58 ADENOIDS AND KINDRED PERILS 

their lack of application. A cheerful disposi- 
tion is often transformed into a melancholy 
one by adenoid growths, and the child pre- 
viously bright and sunny becomes dull, stupid 
and morose. It is said by one authority that in 
seventy-five per cent, of the young men and 
women who prove a disappointment and in- 
cumbrance, rather than a help to their parents, 
the cause may be found in perverted mental 
development due to adenoids. Some time 
ago the writer had occasion to visit a school 
for the backward young in another state and 
was impressed by noticing that the majority 
of its pupils bore unmistakable evidence of 
having post-nasal obstructions, a fact anything 
but complimentary to the management of the 
school. 

There is frequently to be found in these 
cases a hacking cough, which if not present 
during the day sets in shortly after the little 
patient has been put to bed. The function of 
the nose is to warm, filter and moisten the in- 
spired air. When the child breathes through 



THE SYMPTOMS OF ADENOIDS 59 

its mouth the air enters the lungs unstrained 
and without being sufficiently moistened and 
warmed. The consequences are that it ex- 
tracts the moisture from the throat and wind- 
pipe and keeps them dry and irritated. In 
many cases this accounts for the cough from 
which the little patient suffers. 

Enlarged tonsils and adenoid growths are 
responsible for many cases of persistent cough 
in adults. Persons who breathe through their 
mouths carry into the larynx, twenty times or 
so a minute, a current of air which has not been 
freed from dust by the filtering process of the 
nose, and which is not moistened and warmed. 
The consequences are that the larynx is kept 
dry and irritated and responds rapidly to at- 
mospheric changes. Some authorities on the 
throat have reached the conclusion that in 
mouth breathing cases there is kept up a mild, 
almost unnoticed chronic inflammation of the 
larynx which becomes aggravated under the 
influence of exposure to cold or irritation from 



60 ADENOIDS AND KINDRED PERILS 

dust. In children with adenoids an almost 
constant "cold" in the head exists during the 
winter months. The inflammation of the 
mucous membrane associated with this condi- 
tion often extends over the entire throat under 
the exciting influences occasioned by sudden 
changes of temperature, and a catarrhal con- 
dition of the larynx ensues. The mechanical 
irritation of the mucus from the nose trickling 
down the back wall of the throat and invading 
the larynx is often a factor also, in producing 
this character of cough. 

The irritation from "cold" or inhaled dust 
may cause a thickening of the walls of the 
air cells so that proper oxygenation of the 
blood is not carried on. This lack of proper 
aeration of the blood gives origin to a number 
of reflex symptoms. Numerous writers men- 
tion hay fever, Saint Vitus' dance, bed wetting 
and other reflex disturbances as being asso- 
ciated with, and probably caused by adenoids. 
These growths are also thought to be a factor 



THE SYMPTOMS OF ADENOIDS 61 

in the production of convulsions in children, 
because of the improper oxygenation of the 
blood which they cause. 

The crowded mouth, that is, the mouth in 
which the upper jaw is too small for the teeth 
to set without one overlapping another, or 
without the front teeth protruding, is almost 
always due to adenoids. The tongue while 
held in the normal position helps to form the 
arch of the palate during the process of the 
child's development. When the habit of 
mouth breathing is established the tongue falls 
down into the floor of the mouth, relieving the 
arch of the upper jaw of its normal support. 
The weight of the lower jaw while the mouth 
is open, gives rise to a constant pressure of 
the cheek muscles upon the outside of the up- 
per jaw. It is nothing but natural then, that 
this arch, by being robbed of its support from 
within, which is the tongue, and by being 
pulled upon by the muscles from without, 
would not develop in proportion to the other 
parts of the jaw, and that this overlapping and 



62 ADENOIDS AND KINDRED PERILS 

protrusion of the teeth would occur. This 
overlapping is due to the fact that the teeth 
are normal in size and the jaw is smaller than 
normal and therefore room is not afforded 
them without this overlapping process. Such 
a deformity leaves a very unsightly mouth and 
one which does not perform its physiological 
function. 

The arch of the palate is formed by what 
is spoken of as the palate processes. When 
a contraction, or drawing in of the lower part 
of the jaw occurs, these palate processes act 
as fulcra, consequently the bony attachments 
above are spread apart. This spreading 
causes a coincident spreading of the bridge 
bones of the nose, which gives rise to the flat- 
tened appearance so characteristic of adenoids. 
The raising of the roof of the mouth and the 
drooping down of the nasal bridge will cause 
other structural changes in the nose, the most 
harmful of which is the twisting of the sup- 
port of the nasal partition or septum with con- 
sequent closure of the nasal passage. 





DEFORMITY OF THE CHEST OFTEN SEEN IN 
CHILDREN WITH ADENOIDS 



THE SYMPTOMS OF ADENOIDS 65 

On examining the nostrils of those suffering 
from adenoids one generally finds a nasal ca- 
tarrh more or less advanced. The younger the 
child the less is the condition marked as a rule. 
This is easily accounted for. The nose secretes 
several ounces of mucus every twenty-four 
hours, this being used in health in moistening 
inspired air. When normal nasal breathing 
is not carried on, a part of this unused secre- 
tion gravitates to the floor of the nose and de- 
composes. It is true that a portion escapes in 
front, giving rise to the familiar 'running 
nose," but enough remains to produce an ir- 
ritation which aggravates the discharge. 
This is the origin of the catarrh. There is no 
doubt that many children suffer in health by 
the infected mucus entering the stomach, de- 
stroying the digestion, and interfering with 
the appetite. 

In adenoid cases a peculiar deformity of 
the chest may result. This deformity con- 
sists of an expansion of the upper part of the 
chest, a depression of its lower walls and a 



66 ADENOIDS AND KINDRED PERILS 

sinking in of a part of the sternum or breast 
bone. The cause for this may readily be un- 
derstood. Normal breathing is promoted by 
the descent of the diaphram, a powerful 
muscle which divides the chest from the ab- 
dominal cavity. As this muscle descends the 
air rushes in to distend the lungs, the lungs 
themselves taking no active part in the breath- 
ing act. When the breathing is shallow, as 
it always is in cases of adenoids, the air does 
not sufficiently expand the lungs. The pres- 
sure of the air from without forces in the 
most yielding parts of the ribs, the costal car- 
tilages, which are attached to the breast bone 
in front, and the depression ensues. As the 
sides of the chest come in closer and closer, 
the breast bone is forced forward by these car- 
tilages. The lower cartilages, being the 
longer, cause, the breast bone to be pushed out 
most below, and this point is made most promi- 
nent. This deformity, though often perma- 
nent, seems to be of little importance after its 
cause is removed. 



THE SYMPTOMS OF ADENOIDS 67 

One of the first symptoms to be noticed in 
adenoids is intermittent deafness. This dull- 
ness of hearing is noticed in the mild cases 
only when "colds" are present, but in pro- 
nounced cases it is more constant. A brief 
review of the anatomy of the ear will help us 
to better understand the reason for this im- 
pairment of the hearing. 

For convenience of description the ear may 
be divided into three parts, the external ear 
which gathers air vibrations and carries them 
by means of the auditory canal to the drum 
membrane, the middle ear which transmits 
them across its cavity and the internal ear 
which receives them. The little bones of the 
ear, the mallet, anvil and stirrup, are stretched 
across the middle ear cavity from the drum 
membrane to the cochlea. Air vibrations fall- 
ing upon the drum membrane set into mo- 
tion this delicate little chain of bones, and 
through them these vibrations are transmitted 
across the middle ear cavity to the receptive 
apparatus in the internal ear and the impres- 



68 ADENOIDS AND KINDRED PERILS 

sion is carried to the brain and there is regis- 
tered as sound. 

The middle ear is a closed cavity, except for 
a little tube which leads from the throat to it. 
This tube is for the purpose of ventilating the 
middle ear cavity. When this tube becomes 
closed by a plug of mucus being forced into 
it, or by its lumen being shut off by swelling, 
a rarefication of the air in the middle ear is 
established because the fine blood vessels 
which line it take up the oxygen and exhaust 
the air. The semi-vacuum produced by this 
process causes a drawing in of the drum mem- 
brane, it being the point of least resistance, 
and a consequent crowding of the joints of 
these little bones with pressure upon the re- 
ceptive apparatus and attending deafness. 

It is easy to understand how an adenoid 
growth around the orifice of the Eustachian 
tube will interfere with the ventilation of the 
middle ear. The adenoids also harbor more 
or less mucus which clings to them and decom- 
poses. 



THE SYMPTOMS OF ADENOIDS 69 

When the child with adenoids blows its 
nose, infected secretions are forced up into the 
ears where they set up an earache. The 
process of inflammation, which is occasioned 
by these secretions, fills the ear with serum. 
This serum may escape down the tube or it 
may burst through the drum membrane, caus- 
ing the familiar running ear. The conse- 
quences are that the child is deaf. This ac- 
counts for his inattention. What other chil- 
dren in the room hear without difficulty, he 
fails to hear. In an effort to do his best he 
makes an answer — usually the wrong one, to 
his own chagrin and the amusement of the 
class. He is laughed at, becomes discour- 
aged, sullen and apathetic and is often pun- 
ished for a demeanor, which is only a natural 
one when its cause is ascertained. It is not 
to be wondered at that these little unfortu- 
nates lag behind and are known as stupid chil- 
dren. 

Another prolific cause of deafness in chil- 
dren, and one closely associated with adenoids, 



70 ADENOIDS AND KINDRED PERILS 

is diseased tonsils. It is rare to find chronic- 
ally enlarged tonsils without adenoids being 
present. The tonsils may be only slightly en- 
larged or may be swollen so that they almost 
entirely fill the throat. In this latter condi- 
tion their little "crypts," or cavities, are 
greatly distended and are filled with food and 
other debris. These deposits soon become 
putrid and a chronic inflammation or "ca- 
tarrh" of the throat ensues. It may be said 
in a general way that any condition of the 
nose or throat with which is associated a ca- 
tarrhal discharge, is a constant menace to the 
ears. 



Chapter IV 
WHEN IS OPERATION NEEDED 



Chapter IV 
WHEN IS OPERATION NEEDED 

IN this day of over-enthusiastic surgery 
parents often hesitate to have their chil- 
dren operated upon even though they realize 
that they have adenoids. Nor are they to be 
condemned for this conservatism, for in mild 
cases good results may sometimes be obtained 
without surgical interference. It is well to 
remember that a certain amount of lymphoid 
or adenoid tissue in the nasopharynx is nor- 
mal and its presence may do no harm. When 
there is only a slight enlargement of this struc- 
ture, and when the symptoms are not severe, 
results may often be obtained by spraying the 
nose and throat with an alkaline solution. 
For this purpose nothing is more effective 
than a preparation found in all drug stores 
under the name of Doebell's Solution. It is 

73 



74 ADENOIDS AND KINDRED PERILS 

well to use the spray night and morning and 
to observe the precaution of keeping the child 
indoors for half an hour afterwards, for while 
this procedure cleanses the inflamed surfaces, 
it also robs the delicate membrane of its mucus 
which is nature's protection against cold and 
irritation from dust. 

In addition to this the child should take 
breathing exercises night and morning under 
the supervision of some responsible person. 
The child is taught to breathe deeply through 
the nose with the mouth closed and to avoid 
mouth breathing as much as possible at other 
times. 

The following deep breathing exercises are 
recommended by Dr. R. A. Lyster in the 
British Medical Journal of 1905: 

"1. Extend the hands and stretch the arms 
forward at the shoulders leaving about a foot 
between the hands, which should be turned 
with the palms inwards and fingers stretched 
out straight. Slowly move the arms back- 
wards as far as they will go (while deeply in- 



WHEN IS OPERATION NEEDED 75 

spiring), and slowly bring them forwards un- 
til they are in the same position as at the start- 
ing (while deeply expiring). Repeat this 
from three to six times. 

"2. Hold the hands downward with the 
palms against the legs. Raise them with 
palms inwards (inspiring) and when they 
are immediately above the head turn the palms 
outward and slowly bring them down to the 
sides (expiring). Repeat from three to six 
times. 

"3. Hold the hands against the thorax, 
with the fingers pointing inwards and touch- 
ing back to back. Then with a swift move- 
ment swing the arms out as far as they will go 
(while inspiring). Begin again (expiring) 
and repeat half a dozen times. 

"4. Keep the arms dow r n, the palms touch- 
ing the sides, slowly turn the palms outward 
as far as they will go (inspiring), and slowly 
bring them back to the sides (expiring). 
This may be done six or eight times. This 
exercise apparently so simple, expands the 



76 ADENOIDS AND KINDRED PERILS 

chest and presses together the shoulder 
blades," 

The following extract from another work 
by the same author, gives other simple rules 
for deep breathing exercises: 

"These exercises are of great value and 
should form part of the daily training of every 
scholar. It is of great importance that the 
correct method of nasal breathing should be 
taught from the beginning of school life." 

"1. For infants, a simple imitative exercise 
is the most easily acquired. The infant, 
standing or sitting, and watching the teacher, 
places the left hand over the pit of the stom- 
ache and breathes in as she does, noticing the 
hand rise during the inhalation. The child 
then breathes out slowly, the hand at the same 
time sinking. On each occasion the teacher 
must watch the class carefully, and note that 
all the mouths are firmly closed, and that all 
breathing is through the nostrils only. This 
exercise should be repeated about six times 
at least twice daily." 






..V 






TYPICAL FACIAL EXPRESSION RESULTING 
FROM ADENOIDS 

Following picture shows same child three months after operation. 



WHEN IS OPERATION NEEDED 79 



iC ( 



'2. For older children: The teacher start- 
ing from the position of attention should see 
that all the mouths are firmly shut ; then on the 
command 'breathe in 5 (slowly given) instruct 
the pupils to breathe in slowly and deeply 
though the nostrils only, until the chest is fully 
expanded, then on the command, 'breathe 
out' ( slowly given) to breathe out quietly and 
steadily; this exercise should be repeated 
about ten times at least twice daily. When 
the exercise is repeated the commands 'in' 
and 'out' only should be used." 

Sleeping on the side instead of the back will 
greatly facilitate normal nasal breathing. 
When the tendency to mouth breathing is 
marked and persistent a strip of adhesive 
plaster placed across the closed lips may be of 
service. If, after weeks of careful observa- 
tion and treatment there is no marked im- 
provement, an operation for the removal of 
the growth should be performed. 

The removal of adenoids is one of the sim- 
plest of surgical procedures and there is proba- 



80 ADENOIDS AND KINDRED PERILS 

bly no operation which gives such flattering 
results. The change brought about in a very- 
few months subsequent to the operation is often 
a matter of astonishment to the parents of the 
child. His gain in health and strength and 
his rapid strides in school is little short of mar- 
velous. It may be safely said that all opera- 
tions for adenoids in young children, if cor- 
rectly done, are successful. 

While some cases of post-nasal growths re- 
spond to medical treatment, the majority of 
them do not and we must be guided as to the 
necessity for operations by the severity and 
persistence of the symptoms. 

Children who are incorrigible mouth- 
breathers, and who have a discharge from the 
nose, with attacks of intermittent deafness, 
never respond to treatment, and belong to the 
class in which surgical interference is impera- 
tive. Chronic adenoid cases with discharge 
from the middle ear which have resisted all 
treatment should be operated upon. In ade- 
noid children who have developed mental dull- 







FACIAL EXPRESSION OF CHILD THREE MONTHS 
AFTER OPERATION FOR ADENOIDS 

Preceding picture shows same child before operation 



WHEN IS OPERATION NEEDED 8@ 

ness, attended with a general disturbance of 
health, and in cases where there is an obstinate 
cough, the operation is indicated. 

Young adults in whom the adenoids have 
produced their pernicious influences to the 
ears, may often be greatly benefited by a re- 
moval of what remains of the growths, fol- 
lowed by a general treatment under the di- 
rection of the physician. 

Young children who are backward in their 
speech, due to the adenoids interfering with 
the free movement of the soft palate, and 
those who have large faucial tonsils with ade- 
noids, are greatly benefited by the operation. 

Fifty per cent, of all adult cases of nasal 
and ear diseases owe their affliction to neg- 
lected adenoids during childhood, and no- 
where is this lamentable fact more thoroughly 
recognized than in the office of the nose and 
throat specialist. 



Chapter V 
EAR DEFECTS 



Chapter V 
EAR DEFECTS 

THERE is probably no condition whicli 
so retards the progress of a child at school 
as does defective hearing. This is not as un- 
common in children as may be supposed, for 
when it exists it is often overlooked and the 
child's lack of progress and seeming stupidity 
is too often attributed to a lack of interest in 
school work or to stubbornness. This fact 
was very conclusively demonstrated a short 
time ago by a systematic examination of the 
hearing of pupils in a Massachusetts school for 
backward children, which proved that in 
three-fifths of the children, the hearing was 
defective. 

The discovery that a child is deaf will at 
once account for his inattention. It is not to 
be wondered at that he lacks interest in the 

87 



88 ADENOIDS AND KINDRED PERILS 

studies which his normal companions enjoy, 
for what they hear perfectly he catches only 
with the greatest effort, if he does not mis- 
understand it entirely. It is quite obvious 
that such a defect will make a child appear to 
be dull and will lead eventually to an unde- 
veloped intellect. The inattention which this 
disturbance gives rise to causes a lack of pre- 
cision also. He misses the first part of the 
sentence addressed to him by his inattention, 
and in trying to catch it he loses the second 
part. In such cases there is usually some 
thickening of the drum membrane and stiff- 
ness of the joints of the little ear bones which 
transmit the sound waves. The sounds are 
mixed or confused because the membrane and 
ear bones are not quick to convey the vibra- 
tion. 

Nearly all cases of dullness of hearing in 
children are traceable to a catarrhal condition 
of the nose and throat. Here the proverbial 
ounce of prevention is worth a pound of cure. 
Good hearing is best promoted by keeping the 



EAR DEFECTS 89 

mucous membrane of these organs in a healthy 
condition. This is best done by a habitual 
exposure to pure air, thus preventing the 
"colds in the head" which are almost certain 
to be fostered by coddling and an indoor life. 

The ear is an extremely delicate organ and 
should not be indiscriminately interfered with. 
It, more than any other organ, should escape 
the remedies from the family medicine chest. 
Beyond a gentle washing, it is dangerous to 
do anything to the internal part of the ear 
without the advice of a physician. The Ger- 
mans have an adage, "Put nothing but your 
elbow in your ear," and if this maxim were 
adopted as a guide, much mischief could be 
prevented. Picking at the ear with hairpins 
and toothpicks often causes irritation which 
results disastrously to hearing. 

Rupture of the drum membrane, followed 
by discharge, is a common cause of deafness 
in children. This rupture may follow an in- 
fection of the middle ear from some similar 
process in the nose or throat or may be sec- 



90 ADENOIDS AND KINDRED PERILS 

ondary to the acute eruptive fevers, such as 
scarlet fever or measles. Rupture of the 
drum membrane followed by infection and a 
discharge from the ear is often caused by the 
time honored custom of boxing a child on the 
ear. In the light of our present knowledge 
regarding this organ, it is nothing short of 
criminal to resort to this method of punish- 
ment. 

Discharges from the ear, besides frequently 
causing deafness, are dangerous to life be- 
cause of the probability of brain involvement. 
This is now so generally recognized that no 
insurance company will accept as a risk an 
applicant with a chronic ear discharge. Such 
cases should be under the care of the medical 
man until cured. If they are allowed to run 
nature's course, they may become complicated 
by an involvement of the mastoid cells, a con- 
dition which is a constant menace to life. 

The hearing is often found to be impaired 
by a collection of cerumen or wax in the ex- 
ternal canal. Attempts at the removal of 



EAR DEFECTS 91 

this wax should never be made by the unskilled 
and the child should be referred to the physi- 
cian for attention. Eczema of the external 
canal may often lead to an accumulation of 
debris which interferes with the hearing, 
though the deafness soon disappears when the 
cause is removed. 

All cases of deafness in the schools should 
be observed by the teachers and should be re- 
ferred to the parents for appropriate treat- 
ment. Until the child is relieved the larger 
part of the efforts spent in his education will 
be wasted and later he will face the world with 
a serious handicap. It is the teacher's duty 
to impress upon the parents the importance of 
righting this wrong. This may have to be 
done in the face of a great deal of prejudice, 
though procrastination and neglect by parents 
is the exception rather than the rule when they 
are taught to appreciate the situation in its 
true light. 

Statistics have been gathered which go to 
prove that fifteen per cent, of all school chil- 



92 ADENOIDS AND KINDRED PERILS 

dren have defective hearing. It is impos- 
sible to make a correct conclusion regarding 
a child's inattention or backwardness until 
the hearing has received appropriate tests. 
The simplest test for hearing is made with a 
watch. A number of persons with supposed 
good hearing should be tested first so that the 
average distance of hearing for that particu- 
lar watch may be gauged. The same watch 
should afterwards be used in all cases tested. 
The test is to be made in a quiet room, and 
the child must not be allowed to see the watch. 
The watch should first be held at the dis- 
tance at which it was heard by the average ear, 
and then be moved nearer and nearer until the 
tick is audible. It would be well to test the 
power of the voice in children proven defec- 
tive by the watch test. The children are to be 
placed with their backs to the teacher so as 
to avoid the possibility of lip reading. The 
teacher starts at the distance of twenty feet 
from the pupils and gradually moves closer 
while speaking until his words can be heard 



EAR DEFECTS 93 

and repeated by the children. He will thus 
learn at what distance he must stand from the 
class, in which these children are, while giv- 
ing them exercises. 



Chapter VI 
THROAT ABNORMALITIES 



Chapter VI 
THROAT ABNORMALITIES 

WE have made mention of the fact that 
deafness is often associated with dis- 
eases of the throat and it will be appropriate to 
consider here also, throat abnormalities which 
directly influence the voice. These are often 
due to the rapid development of the larynx 
which occurs in boys from fourteen to sixteen 
years of age and in girls a year or two sooner. 
During the time occupied by this change the 
throat if not properly cared for, may be hin- 
dered in its development, a chronic "cracked" 
voice being the result. During this period 
voice exercises must be regulated so that the 
vocal cords will not be unduly strained. Sing- 
ing exercises are to be limited and the pupils 
should not be encouraged to reach high notes. 
During singing lessons the teacher should no- 

97 



98 ADENOIDS AND KINDRED PERILS 

tice that there is no excessive action of the up- 
per chest, this being a sign of abdominal con- 
striction. It is very necessary to see that 
there is no impediment whatever to the ab- 
dominal muscles caused by tight belts or cor- 
sets, for this prevents the production of the 
voice in its natural manner and causes fatigue. 
If the collar bones are seen to rise and fall ex- 
cessively it is very probable that the abdom- 
inal movements are difficult or impossible, due 
to a constricted abdomen. 

A very common cause for hoarseness is to be 
found in laryngitis brought on by exposure to 
draughts, sitting during school hours with 
cold, wet feet, etc. Sudden exposure to cold 
air after prolonged sitting in a warm close 
room, may give rise to disturbances of the 
larynx. On coming out of a warm, badly 
ventilated room into the cold air, the mucous 
membrane of the larynx suddenly relaxes and 
the finer blood vessels become engorged and 
inflammation ensues. This is one of the many 
reasons why the schoolroom should be kept at 



THROAT ABNORMALITIES 99 

a moderate temperature and should be well 
ventilated. 

The use of iced drinks or extremely hot 
drinks relaxes the mucous membrane of the 
throat and should be discouraged. Muffling 
up the throat is not a good practice because 
it lessens its normal resistance. Over indul- 
gence of this kind is injurious because it 
destroys the power to withstand the effects of 
slight changes in temperature. The hardiest 
specimens of American manhood are to be 
found in our navy, and these go the year round 
without any covering whatever to the throat, 
and are not troubled to any extent with dis- 
eases of that organ. 

Children, either from timidity or careless- 
ness, are apt to fall into the habit of speak- 
ing in a mumbling manner with teeth closed 
and lips half open. This causes imperfect 
breathing and incomplete aeration in the 
lungs. These cases should be taught to 
speak in a natural tone and to articulate 



100 ADENOIDS AND KINDRED PERILS 

plainly. This timid habit may be overcome 
by habitual exercises so that reading or speak- 
ing will be neither painful nor injurious. 



Chapter VII 
ABNORMALITIES OF THE EYE 



Chapter VII 
ABNORMALITIES OF THE EYE 

IT is beginning to be generally recognized 
that the modern requirements of school 
life often result in serious injury to the 
pupils' eyes. Not only do conditions which 
interfere with the child's vision retard his 
mental development but they are often a 
menace to his physical welfare. A great 
many children struggle along at schools with 
severe headaches and lassitude caused by eye 
strain. They may have blurring of vision so 
that the print looks indistinct and confusing. 
An effort to see print causes a sense of weari- 
ness and fatigue in children who have errors 
of refraction, conditions in which the rays of 
light do not focus on the retina without an 
excessive amount of muscular effort. When 
such conditions exist the child brings all his 

103 



104 ADENOIDS AND KINDRED PERILS 

surplus nervous energy into use in order to 
cause the light rays to focus correctly. There 
is a constant leaking of nerve force. Is it a 
wonder then that the muscles get tired and 
fail to act occasionally? Is it a wonder that 
the child is nervous and that his head aches, or 
that he is unable to keep up with other children 
in his class? 

No other organ of the body is as easily in- 
jured by improper usage and care as is the 
eye, and no other organ has less power of re- 
establishing a normal condition after mischief 
has been done to it. Excessive school work 
at an early age, before the coats of the eye 
are strong and firm; incorrect position of the 
book while reading and prolonged periods of 
"cramming" in later school years when chil- 
dren are overpressed, for show or for pure 
vanity, all work their baneful influences on 
the eye. 

The eye should be considered as an optical 
instrument of rare delicacy, and it should at 
least receive as much care as would an expen- 



ABNORMALITIES OF THE EYE 105 

sive instrument purchased from an optical 
house. Often it does not get this care but if 
we could look into the future of these mis- 
treated cases and see the misfortunes which 
await them, we might hope for a correction 
of the tendency to disregard its proper care. 

Excessive strain upon the eye brought about 
by the incorrect focusing of its muscles, or 
from prolonged periods of study without the 
proper time for rest, will not only permanently 
injure the eye but will demand an excessive 
amount of nervous energy with harmful re- 
sults to the health generally. 

The body has been aptly compared to a 
manufacturing establishment. The brain is 
its superintendent who sits at his desk where 
he receives communications from the various 
departments and sends out to them the desired 
instructions. The stomach department, the eye 
department, the liver department, are regu- 
lated at his command, and when all are work- 
ing in harmony there is an equal distribution 
of his attention to these organs. If for any 



106 ADENOIDS AND KINDRED PERILS 

reason there is a disturbance in one depart- 
ment, his whole attention is directed toward 
regulating its grievance, and the other depart- 
ments suffer from neglect. So in eye strain, 
when the focusing muscles fail to do their 
work, the brain in an effort to supply them 
with the necessary nervous energy neglects 
the other organs in proportion, and in addi- 
tion to the harm done the eye, the work of 
physical deterioration begins. 

The organ of vision is a globular body 
placed in the orbit which protects it. Re- 
duced to its simplest parts, it consists of the 
cornea, which is often spoken of as the glassy 
part of the eye. It is tough, transparent and 
slightly more convex than the other coats of 
the eye. The side and back walls are formed 
by the sclera, a very dense membrane. It 
is opaque and perforated behind by an open- 
ing through which the optic nerve enters. 
Just within the sclera and attached to it is 
the choroid, a layer of pigment in which are 
set most of the blood vessels of the interior of 



ABNORMALITIES OF THE EYE 107 

the eye. As this coat extends forward there 
is a gradual change in the arrangement of its 
cells and fibers until it reaches the front of the 
eye where it goes to form the iris, a delicate 
curtain which regulates the amount of light 
that the eye needs. This curtain is of differ- 
ent color in different individuals. In the 
blond it ranges all the way from a hazel to a 
blue; in the brunette is in medium or dark 
brown. When one looks into the eyes of his 
friend it is this iris which is seen, and much of 
the "expression' ' which the eye has is due to 
the color and markings of the iris. 

The light enters the eye through the pupil, 
which is seen as a black spot, the "sight," in 
the middle of the iris. It contracts and ex- 
pands in order to regulate the amount of light 
which the eye needs. The action of the pupil 
may be studied by watching an eye closely 
while it rests upon a light and then is turned 
to a dark corner of the room. In the former 
position it contracts in order to shut out an ex- 
cess of light; in the latter position it grad- 



108 ADENOIDS AND KINDRED PERILS 

ually expands. In going from the light into 
a dark room, objects are obscured at first and 
then gradually appear. This phenomenon is 
due to the fact that on entering the room the 
pupil was contracted and later, acting under 
the influence of the diminished light, its grad- 
ual dilation occurred. 

The optic nerve after it enters the globe, is 
spread out over its walls and forms the retina 
which is the receptive apparatus of the eye. 
Upon it the image is focused and the picture 
thus formed is transmitted to the brain. Its 
most sensitive portion is known as the "yellow 
spot" and the focusing apparatus of the eye 
directs the light rays so that they fall upon this 
sensitive spot. 

The crystalline lens is a flexible, transparent 
body contained in a capsule, and is placed di- 
rectly behind the iris, with an attachment to 
the ciliary or focusing muscle. Its function 
is to contract rays of light and cause them to 
fall upon the retina where they are received 
and carried to the brain in what we call sight. 



ABNORMALITIES OF THE EYE 109 

When we look at objects near at hand this cil- 
iary muscle comes into play and contracts the 
lens, making the short rays of light fall on the 
retina at the necessary point. 

The various excursions of the eye within 
its orbit are controlled by a set of six muscles. 
Four of these muscles are used in directing the 
eye from side to side and up and down. 
These are called the recti muscles. Two 
other muscles, the "obliques" are used to give 
the eye a rotary motion. The action of these 
muscles is such that rays of light coming into 
the eyes from different distances are focused 
without the consciousness of their possessor. 
The closer an object is to the eye, the more 
must it converge, and by these muscles the 
act of convergence is produced. 

The eye has been frequently compared to 
a camera. To one who has a knowledge of 
the one, the mechanism of the other is readily 
understood. The outer coat or sclerotic 
corresponds to the body of the camera box. 



110 ADENOIDS AND KINDRED PERILS 

The cornea, or front part of the eye, takes the 
place of the point through which light enters 
the camera, and the black paint on the inside 
of the camera has its duplicate in the dark 
pigment or choroid in the eye. They are both 
vised for the absorption of light. 

The amount of light entering the eye is 
regulated by the iris; in the camera the slid- 
ing screen serves the same purpose. The 
crystalline lens and the camera lens have the 
same function to focus the rays of light and 
form an inverted image on the screen behind. 
In the eye this screen is the retina, in the cam- 
era it is the sensitive plate, or film. The film 
of the camera receives the rays of light, after 
which they are transferred to the photograph; 
the retina takes the impression and transfers 
it to the brain and a visual image is made. 
To one who wishes to receive a valuable les- 
son on the eye a quarter of an hour may be 
spent to great advantage in taking a camera 
to pieces and examining its parts. 



ABNORMALITIES OF THE EYE 111 

In the preceding illustration we have spoken 
only of the normal eye in which light rays 
focus correctly. While the camera is a math- 
ematically correct instrument, the eye unfor- 
tunately is rarely so. The majority of eyes 
met with in actual life, vary considerably from 
a mathematical standard, and are poorly 
adapted, without much strain, for close vision 
or for seeing at a distance. The reason for 
this is that at birth the eye is more or less flat- 
tened and will remain so unless circumstances 
are favorable to its developing a normal shape. 
Among nomadic people the eye is usualfy per- 
fectly developed, but in civilized man the nor- 
mal eye becomes abnormal because of its rar- 
ity. 

Nearly all school children have errors of 
refraction of a greater or less degree. By this 
is meant that the light rays as they enter the 
eye do not focus properly on the retina with- 
out an excessive amount of strain to the cil- 
iary or focusing muscle. In the normal eye 
the light rays reflected by the cornea and crys- 



112 ADENOIDS AND KINDRED PERILS 

talline lens come to an exact focus on the 
retina without any muscular effort whatever. 
It will be easy to understand how such an eye 
will perceive distant and close objects with 
the same degree of comfort. 



Chapter VIII 
COMMON EYE DEFECTS 



Chapter VIII 
COMMON EYE DEFECTS 

FAR SIGHT 

THE most common eye defect from the 
standpoint of light refraction is "far 
sight/' The farsighted eye has its axis from 
front to back shorter than normal. We have 
already observed that at birth all eyes have 
the short axis. A picture falling on the retina 
in such an eye will make a blurred image with- 
out the help of the focusing muscle. When 
the eye looks at distant objects, this muscle 
acts or "accommodates" in order to bring the 
focus correct so that the object will be seen 
clearly. But now should the eye attempt to 
see objects near at hand, it can not possibly get 
a distinct image. The object looks blurred be- 
cause the eye has used up all of the focusing 

115 



116 ADENOIDS AND KINDRED PERILS 

power or accommodation in viewing distant 
ones. A child with this defect fails utterly at 
school. What the more fortunate children 
see clearly, he fails to see. During the weary 
hours of the day his ciliary muscle is tugging 
and straining at the crystalline lens in an ef- 
fort to make the light rays focus. He soon 
uses up his reserve nervous energy, the eyes 
act for a few minutes and then "let go" and 
the print blurs. He has constant headache, 
becomes apathetic or is nervous and fretful. 
His lids itch and burn and his eyes become red 
and watery. Gradually an aversion to all 
near work is developed; study is avoided and 
his attention is turned to out door sports for 
he sees these sufficiently well to enjoy them. 
Now let us put a convex lens in front of 
this eye. This lens concentrates the light 
rays and causes them to focus on the retina 
in the proper manner without any effort upon 
the muscle. A wonderful change is brought 
about. Close work now becomes a pleasure. 
The headache ceases and the nervousness dis- 




\ 



'4 




GIRL WITH STRABISMUS OR CROSSED EYES 

Following picture shows same child wearing correcting glasses 



COMMON EYE DEFECTS 119 

appears, because the leakage of nerve force is 
stopped. 

CROSSED EYES 

In neglected cases of farsight, strabismus or 
crossed eyes is apt to result. It seems to be a 
law of nature that the more the ciliary muscle 
is needed in "accommodation" the more con- 
vergence occurs to the eye. A very strong 
impulse is given to turn the eye in when "far- 
sight" exists. In cases of this character the 
drawing in of the recti or converging muscles 
goes on until the child develops double vision. 
When he looks at one object, two objects are 
seen, a very confusing phenomenon. Eventu- 
ally he learns to disregard one object. In 
other words he finds, unconsciously to himself, 
that he can see better with one eye than with 
two, and the crossed eye follows the course of 
least resistance which is a turning inward 
toward the nose. 

This very unsightly and injurious defect 
may be prevented, or corrected when estab- 



120 ADENOIDS AND KINDRED PERILS 

lished, by wearing correctly adjusted lenses. 
It is very important that these cases be at- 
tended to as soon as discovered because the 
retinal fibers of an unused eye atrophy or 
waste away from disuse. 

The majority of unused eyes go wholly or 
partially blind; besides the eye in use is sub- 
jected to twice its normal work very much to 
the detriment of its possessor. In children 
who have reached the age of twelve or fourteen 
years an operation usually has to be done, a 
fact which intensifies the importance of cor- 
recting this defect earlier in life when well 
fitted lenses are all that is necessary. 

NEAR SIGHT OR MYOPIA 

Cases of nearsightedness are less common 
than the farsighted ones, though they are not 
so apt to escape notice. This defect is due to 
an elongated eyeball in which light rays from 
a distance, instead of focusing on the retina, 
come to a point in front of it and cross, thus 
making a blurred image. We have seen that 







WEARING GLASSES FOR CORRECTION OF STRABISMUS 

Same child as shown in preceding picture 



COMMON EYE DEFECTS 123 

children are born with flat or "farsighted" 
eyes. The eyes which have a tendency to 
short sight, gradually pass from the flat to 
the elongated type. Under favorable condi- 
tions the eye tends to assume a normal shape 
as adult life is reached and becomes approxi- 
mately spherical. When close vision is en- 
couraged in infancy, and when excessive use 
of the eye is permitted in early childhood the 
elongation of the globe is hastened and the 
child becomes shortsighted. 

It is thus clear that the demands made upon 
the pupil by our modern system of education 
are often responsible for this deformity. It 
is more often seen in children who are suffer- 
ing with physical or nervous disease than in 
the healthy ones. The schools in the con- 
gested districts of our large cities invariably 
have an enormous preponderance of short- 
sighted pupils. Unfortunately this condition 
often progresses as the child advances in age 
and in extreme cases continues to get worse 
steadily until middle life is reached. 



124 ADENOIDS AND KINDRED PERILS 

The correction of shortsight in school chil- 
dren consists of the adjustment of concave 
lenses which spread light rays and in the care- 
ful regulation of the amount of work that 
should be done. Writing periods should be 
very brief, for this character of work is par- 
ticularly trying to the eyes. Home lessons 
should not be permitted. In the majority of 
homes there are neither proper desks nor 
proper light. The lack of the former tempts 
the child to assume incorrect positions, thus ag- 
gravating the defect. Bad light causes strain 
which certainly does not promote a develop- 
ment of the eye toward a standard ; besides the 
eye tires after a long day's work and is not in 
a fit state to be used. 

Long hours are harmful because they give 
rise to a congestion of the ocular blood ves- 
sels and a strain of the muscles used in focus- 
ing. This strain differs from other kinds of 
physical exertion. Cases of near sight should 
be encouraged to live out of doors as much as 
possible and to use their eyes for distance. If 



COMMON EYE DEFECTS 125 

this is persisted in a relaxation of the muscles 
is brought about and a tendency of the eye to 
assume a normal contour is produced. 

ASTIGMATISM 

Astigmatism is a condition which gives rise 
in school children to a great deal of discom- 
fort. In this disorder the eye has what may 
be termed a double focus. The horizontal light 
rays, for instance, may focus on the retina 
while those in the perpendicular meridian come 
to a point in front of the retina. This is due 
to a lack of correct curvature of either the 
cornea or crystalline lens. If one should look 
into the bowl of a highly polished spoon, he 
may be helped to understand this phenomenon. 
If the spoon is held vertically the focus is 
lengthened ; if held horizontally, it is widened. 
There is an over focus in one direction and an 
under focus in the other. Now this is just 
what happens in the astigmatic eye. The rays 
of light as they pass through the cornea and 



126 ADENOIDS AND KINDRED PERILS 

lens are not brought to one point and a blurred 
image falls on the retina which necessitates 
muscular strain before it can be equalized. 

The child with a high degree of astigmatism 
suffers constantly from headache and nervous- 
ness because of this strain. He is apt to form 
the habit of blinking his eyes and holding his 
head in unnatural positions in an unconscious 
effort to shut out the offending rays. While 
this abnormality gives rise to untold mischief 
if not remedied, it may easily be corrected with 
cylindrical lenses adjusted so as to equalize 
the focus of the light rays. 

There seems to be a prejudice in the minds 
of parents and some teachers against the use 
of glasses for children, because "they depend so 
upon them." It is true that the child will have 
to depend upon them but this is no reason why 
he should be denied them any more than a child 
with a diseased spine should be denied a brace 
which gives him support and relieves his pain. 
What he saves in wasted nervous energy, with 



COMMON EYE DEFECTS 127 

all the ills incident to it, will more than com- 
pensate him for the trouble his glasses will 
cause him. 

TRACHOMA 

One of the greatest menaces to pupils 5 eyes 
is trachoma or granulated lids. This disease 
does its work so insidiously and its effects are 
so permanent and disastrous that it has be- 
come a positive peril in the schools. The im- 
portance of preventing the spread of trachoma 
has only recently become recognized by our 
immigrant authorities. The examination of 
all immigrants is now carefully done, however, 
and all infected cases are excluded. About 
six thousand immigrants were sent back last 
year from New York alone. In some Eu- 
ropean countries trachoma is responsible for 
an appalling per cent, of blindness. In Hun- 
gary one-third of the population is affected 
by it. Its great prevalence there prevents 
the maintenance of a standing army free from 
it. Many of the recruits accepted for serv- 



188 ADENOIDS AND KINDRED PERILS 

ice have trachoma and they are treated and 
kept in a semi-quarantine until they are either 
discharged from service or cured. 

Fortunately the disease seems to be milder 
in this country than in Europe, though even 
here it is responsible for a large per cent, of 
the cases in our asylums for the blind. Be- 
cause of its contagious and infectious nature, 
and the mildness of its symptoms in the early 
stages, all schools should be regularly exam- 
ined and the cases discovered be excluded. 
This precaution followed by appropriate treat- 
ment of the infected cases offers the only hope 
of its eradication. 



Chaptee IX 
THE CARE OF THE EYE 



Chapter IX 
THE CARE OF THE EYE 

IN order that the eye should be made to 
cope with the demands made upon it in 
after years, it should receive the most careful 
attention during school life. A child should 
leave school with at least as good eyes as he 
had when he entered. Under a rational sys- 
tem of education, they should improve rather 
than deteriorate. Unfortunately educators, 
by disregarding the capacity of the eyes for 
work, and the simple rules for promoting the 
welfare of the eyes of the pupils, often do an 
incalculable amount of injury to this delicately 
complex organ. 

When a child leaves home and enters school 
the parents' responsibility during school hours 
is transferred to the teacher, and the teacher 
cognizant of this responsibility will do every- 

131 



132 ADENOIDS AND KINDRED PERILS 

thing possible to conserve the good health and 
good vision of the pupils. 

The teacher who observes the essential pre- 
cautions necessary to prevent injury to the 
eyes of his pupils, will see that the room is well 
lighted. The light should be tested in every 
part of the room which is occupied. The 
desks should be placed so that the light will 
fall from behind. It should fall upon the 
child's work from the left so that shadows will 
not be cast by the head, shoulders and hand, 
in writing. Under no circumstances should 
the children sit facing the light. 

The pupils should sit erect with desks so 
arranged that their work is not more than 
thirty degrees below the level of the eye. 
Stooping over print brings undue strain upon 
the external eye muscles, besides in this posi- 
tion, the blood gravitates to the eye and a con- 
gestion is soon set up. Every school room 
should possess a Snellen's test chart which may 
be obtained from any optician. With this test 
it is a very simple matter for a teacher to de- 



THE CARE OF THE EYE 133 

termine in a few minutes whether the child 
needs the attention of an oculist. If the 
pupil can read the "20" line at a distance of 
twenty feet, it becomes evident that little, if 
any, eye strain exists. On the other hand, 
those proven defective by this test, those with 
red congested eyes, who peer and blink when 
they apply the eyes for close vision, or those 
who hold the head sideways or slanting, the 
squinting cases, and the ones who tire quickly 
and complain of headache should be sent to 
the parents for appropriate treatment. 

Such a course on the part of the teacher 
would not only prevent much suffering and 
injury to an important organ but a possible 
loss of an invaluable sense. 



Chapter X 
BAD POSTURES 



Chapter X 
BAD POSTURES 

IT is very important that pupils be in- 
structed in assuming correct postures dur- 
ing school hours. Permanent deformities 
have been caused by incorrect positions long 
continued. Especially is this to be noticed in 
children in whom the general physique is be- 
low normal. 

Distorted spinal columns, sunken chests 
and stooping shoulders with their attendant 
physical ailments are often seen to follow a 
disregard of this very important precaution. 
The question of correctly made desks and seats 
has attracted a great deal of attention re- 
cently, and it is commendable that most schools 
are immeasurably better equipped at this time 
than in former years, yet some teachers are 
prone to give more attention to the desks than 

137 



138 ADENOIDS AND KINDRED PERILS 

they do to the pupils. A good desk is un- 
questionably better than a poor one but the 
modern completeness of equipment is apt to 
divert our minds from the essential points in 
maintaining good postures. 

The posture of the child should be closely 
supervised by the teacher. The ideal position 
when sitting is one where the body is placed 
symmetrically. Bodily positions are main- 
tained by the skeleton and its muscular sup- 
port. Where the muscles are in modified 
activity, as they are when the child sits prop- 
erly, no harm will result, but where the pupil 
stoops or twists the body upon itself a part of 
the muscles only are at work supporting the 
frame. This, long continued, goes beyond the 
point of exercise and becomes strain which is 
as harmful as exercise is healthful. 

The correct posture during study hours is 
one in which the body is held symmetrically, 
for then, what may be termed muscular econ- 
omy is attained. In such a position, the pel- 
vis rests firmly upon the seat, instead of being 



BAD POSTURES 139 

tilted and the thigh bones support part of the 
body weight. The spinal column is erect and 
maintains a normal curvature and the head 
is so placed that it does not overwork the mus- 
cles of either the front or back of the neck. 
The frame is in what may be termed a state 
of balance, and the position is maintained more 
by gravity than by muscular activity. 

The child's back should be suitably sup- 
ported by the back of the seat and the desk 
must be accurately adjusted to meet his neces- 
sities. The feet, instead of dangling a few 
inches above the floor, should rest firmly upon 
it. If the seat is too high, the child's circula- 
tion is impeded by his supporting the weight 
of his legs with the back of his thighs. There 
is also an undue tension upon the leg muscles, 
which is tiring and injurious. The back rest 
inclined slightly backward, should be of such 
a height that it fits under the shoulder blades, 
bringing the support about the small of the 
back where it is most needed. 

The desk must not be set so far forward that 



140 ADENOIDS AND KINDRED PERILS 

the pupil has to lean over or so low that he has 
to stoop. It should not be too high necessitat- 
ing the raising of the elbows and shoulders 
to reach up to it. Leaning over low desks 
produces a rounding of the back and a con- 
tracting of the chest. Leaning forward in- 
creases the dorsal curvature of the spine and 
decreases the lumbar curvature. A constric- 
tion of the ribs is also produced, resulting in a 
contraction of the chest cavity and a reduction 
of its capacity. In addition to this the front 
part of the abdomen becomes folded upon it- 
self and its contents are constricted. 

Desks and seats of various sizes to meet the 
requirements of the pupil should be provided. 
In other words the school furniture should be 
made to fit the child instead of the child being 
distorted to fit the furniture. 

Faulty positions in reading are potent 
causes for various eye defects. When reading 
the pupil should sit erect with the book held 
at least fourteen inches from the eye. Lean- 
ing over the book brings the eye too close to 



BAD POSTURES 141 

the print and is thereby responsible for many 
cases of shortsightedness. The closer the eye 
is to the book, the greater must be the degree 
of convergence of the eyeballs, and the more 
intense the strain, besides the sweep of the eye 
at close range is greater than at a longer range 
and the demand upon the extrinsic muscles is 
increased. 

In Germany the tendency toward shortsight 
is so great that the authorities in some of the 
schools have, of late, been trying to overcome 
it by peculiarly constructed desks. The writer 
visited one of these schools sometime ago where 
he had the opportunity of examining these 
rather crude appliances. They consist of bars 
of iron attached to the desks in such a manner 
that the pupil finds it impossible to bend over 
his work. These are used, of course, only on 
the desks of pupils who are found to be de- 
veloping near sight. 

Children are often allowed to read small 
print at too early an age, while the coats of the 
eye are delicate and easily deformed, and this 



lm ADENOIDS AND KINDRED PERILS 

inevitably produces results which are as unfor- 
tunate as they are permanent. Concentration 
of vision for long periods in young children is 
liable to be exceedingly injurious to the eyes. 
Ocular defects are rare in the young who are 
reared in the country among healthful sur- 
roundings and who, instead of being crowded 
at school, have spent much of their time in the 
open air. In the country vision at long range 
is constantly practiced, thereby offsetting the 
evil effects of school work. 

Every acute observer has noticed that 
sailors, surveyors, hunters and other persons 
who exercise their eye muscles out of doors 
have good sight and that the housed-up col- 
lege student is usually suffering from some de- 
fect in vision which he has had corrected by 
glasses. This seems to be a penalty inflicted 
upon us by nature for our modern methods of 
obtaining "book learning.' ' This tendency 
toward errors of refraction may be overcome 
in a manner by more exercise out of doors 



BAD POSTURES 143 

where the eye is exercised and strengthened by 
distance vision. 

While, as already noted, the demands of 
school life work physical hardships upon chil- 
dren and often result in permanent injury to 
the eyes, judicious training of the pupils in 
the proper methods of holding the book and 
assuming proper positions will, to a great ex- 
tent, protect them from this kind of physical 
deterioration. 

WRITING 

Inspection of the back of a normal child 
will show a convexity of the vertebrae or back- 
bone between the shoulder blades and a con- 
cavity at the loins or small of the back. These 
are the natural curvatures of the spine, which 
besides giving grace to the body, equalize the 
gravity of the trunk while the erect posture 
is being maintained. But if this column of 
disks composing the spine are seen to deviate 
to one side or the other it constitutes a de- 



144 ADENOIDS AND KINDRED PERILS 

formity. Many children in school are seen to 
have this lateral bending of the spine and it 
has been found by authorities on the subject 
that, in many cases, the cause may be traced 
to incorrect writing postures. 

One very harmful position for writing is 
where the right hand and arm are supported 
by the desk, while the left arm dangles down- 
ward unsupported. The weight of the body 
with the child in this position, pulls the muscles 
of the back in one direction and the process of 
curvature is begun. In children all of the 
bones are soft and pliable, and an incorrect 
position which would produce no lasting ef- 
fect in an adult will be the cause of results in 
a child which are irremediable. Even slight 
curvatures in children's spines lead to a further 
deviation from the perpendicular during the 
course of growth and they, besides causing a 
loss of appearance, predispose to a general 
deterioration in health. 

Children in whom these lateral curvatures 



i 





INCORRECT WRITING POSITION 
Note the lateral curvature of the spine 



BAD POSTURES 147 

are found usually have illy nourished muscles. 
They are the neglected children who are 
brought up with insufficient outdoor exercise. 
This may be suggested as an illustration of the 
ill effects resulting from lack of physical in- 
struction in the schools. It has been observed 
that when classes receive calisthenics daily and 
where out of door games are encouraged there 
is a diminution in this lateral curvature. 

Writing is an extremely complicated and 
special act and is always a severe trial to the 
young child. In early youth the child has not 
learned to use a few of his muscles at a time 
but has a tendency to use groups of muscles 
together. In the act of writing he must use 
a few muscles from several groups. The ef- 
fect is to produce an unnatural strain to the 
body, the position of which he frequently 
changes in an effort to relieve the tension and 
fatigue that is brought about. He crosses his 
left leg over his right one, resting his 
weight on the right side of the pelvis and 



148 ADENOIDS AND KINDRED PERILS 

this position more than any other he could as- 
sume assists in increasing the curve of the spine 
which has already been commenced by droop- 
ing his left shoulder. He leans forward com- 
pressing the abdominal contents and forces 
them into unnatural positions. In this posi- 
tion he brings his eyes too close to the copy, the 
neck is twisted so that the axis of vision is 
perverted by one eye being on a different level 
from the other and this may be one of the 
fruitful causes of shortsight. 

The writing lesson should come immediately 
after a period of exercise, which stimulates the 
resistance of the trunk muscles and restores 
their tone. Writing should continue but a 
brief time without a pause for rest. A min- 
ute's rest occasionally will help the muscles to 
relax, after which the writing may be con- 
tinued without inconvenience. These simple 
measures put into use, will to a great degree 
prevent the evil results of the most physically 
trying act of school life. 








BAD STANDING POSITION 
In this position the pelvis is tilted and the spinal column curved laterally. 



BAD POSTURES 161 

STANDING 

The positions for standing in classes should 
depend upon how long a period the child is 
obliged to be upon the floor. The ideal posi- 
tion for short periods is one where the heels 
are slightly separated and the weight is equally 
divided between the two legs. With the body 
symmetrically placed the weight is thrown 
slightly on the balls of the feet, the shoulders 
are thrown back and the head is erect with the 
chin drawn slightly inward. This position, 
ideal as it is for short periods, can not be kept 
long without fatigue. The rigidity of the pose 
after a time produces an unnatural strain and 
is followed by a desire to alter the position of 
the body for the purpose of relieving the ten- 
sion and fatigue that is produced. In order 
to relieve the tension the child has a tendency 
to relax the vertebral column, bend the knees 
slightly and throw the head forward. This is 
a position as bad as can be imagined. 



152 ADENOIDS AND KINDRED PERILS 

After short periods of standing the child, 
if correctly instructed, will slightly advance 
one foot, thereby bringing the weight of the 
body on the posterior leg, while the muscles of 
the forward one are relaxed and resting. This 
position may be varied by alternately placing 
the opposite foot in advance. Such slight 
changes in posture are the best remedy for re- 
lieving the fatigue and preventing the awk- 
ward standing positions which are fostered in 
badly conducted schools. 



Chapter XI 
NERVOUS DISORDERS 



Chapter XI 
NERVOUS DISORDERS 

THE seat of nervous force lies in the nerv- 
ous system. This is true of bodily force 
as well. From the nervous system is received 
the power which makes the heart to beat, and 
which causes the other organs of the body 
to perform their various physiological func- 
tions. The physical machine may be said to 
be driven by brain power. The brain not only 
governs the machine but in turn is governed 
by it, for its structure is dependent for nourish- 
ment on the very organs under its control. 
Thus will fright, worry or suspense cause a 
derangement of digestion, which will in turn 
lead to improper brain nourishment and 
eventually will terminate in a permanent dis- 
ability to the functions of both brain and stom- 
ach. 

155 



156 ADENOIDS AND KINDRED PERILS 

School work is the cause of much brain ac- 
tivity. The child's brain in action uses up a 
portion of its tissues, which must be removed 
and replaced as fast as used up, if its equi- 
librium is to be maintained. This balance can 
only be kept up when plenty of time for rest 
and sleep is given. When the brain is 
"crammed" with intellectual work, and when 
insufficient time is given for the removal of 
brain waste, and for brain repair, the nervous 
system suffers and the seeds are sown for a 
full harvest of nervous disorders. 

Nearly every teacher will be able to call to 
mind cases of precocious children which illus- 
trate this rule. Exceptionally rapid mental 
growth is sometimes to be found in children of 
an irritable temperament. This emotional, 
restless disposition gives rise to an ability to 
grasp mental problems with great rapidity. 
Ambitious parents often urge their children 
on in their intellectual pursuits until a period 
of brain fatigue is reached, and they become 



NERVOUS DISORDERS 157 

victims of one or more nervous diseases. A 
teacher should regard a child of this type with 
grave suspicion. They should see in this pre- 
cocity evidence of weakness, not strength, and 
should seek to restrain rather than encourage 
the child's aspirations to outshine its fellow 
pupils. 

The nervous system is built up slowly and 
its over stimulation will rarely fail to produce 
destructive changes. An expensive electrical 
machine may be destroyed in an instant by a 
lack of observation of the laws of electricity, 
and a machine of this kind will rarely be found 
in the hands of a novice. If the teacher will 
realize that in his precocious pupil he has to 
deal with a machine which is regulated by laws 
as infallible as those governing an electrical 
device, which machine may, if not supervised 
properly, destroy itself automatically, he will, 
by prudent restraint, avert the catastrophy 
of a nervous explosion. 

Actual brain disease is often due to a failure 



158 ADENOIDS AND KINDRED PERILS 

to recognize in the exceptional mental activity 
of school children the danger signal of a 
lamentable fall. 

CHOREA OR SAINT VITUS DANCE 

Saint Vitus Dance is a very distressing 
nervous disorder which is not infrequently 
found among school children. This unfortu- 
nate condition is characterized by irregular, 
spasmodic movements of the voluntary muscles. 
In mild cases there will only be noticed a tend- 
ency toward clumsiness in the child, or an un- 
easy, spasmodic shuffling of the feet or slight 
jerking movements of the hands. In others 
a tendency toward twitching of the muscles of 
the neck may be the only symptom observed. 
In more pronounced cases many groups of 
muscles are affected and the child jerks vio- 
lently. Often the muscles of the face are in- 
volved, giving rise to a series of grimaces and 
curious twitching of the lids, lips and angles 
of the nose. The speech is often disturbed, 
articulation at times being impossible. All 



NERVOUS DISORDERS 159 

the symptoms are exaggerated by excitement 
or by the knowledge that someone is watch- 
ing. There is often a distressing opening and 
closing of the mouth, the jaws being violently 
snapped together. In other patients the 
tongue is quickly protruded and withdrawn. 
The diaphragm is sometimes involved, giving 
rise to a series of jerking grunts. 

When the leg and arm muscles are affected 
there may be a constant repetition of purpose- 
less movements caused by repeated spasms of 
the same muscle groups. In severe cases the 
patient may be unable to walk or to help him- 
self in any way. In many cases the groups of 
affected muscles become exhausted so that a 
condition simulating paralysis results. Men- 
tally the child is extremely irritable, and is un- 
able to concentrate his attention for more than 
a brief period. He is entirely unfit for school 
work, and attempts at concentration only in- 
crease the bad effect of the disease. 

St. Vitus Dance may be found in children 
of all ages, but it occurs most frequently be- 



160 ADENOIDS AND KINDRED PERILS 

tween the ages of seven and thirteen years. 
Many conditions have been mentioned by 
writers as predisposing factors in its produc- 
tion, the most common of which are diseased 
tonsils, errors of vision, intestinal disturbances 
and over pressure at school. Statistics leave 
no doubt that the disease occurs oftenest among 
overworked school children in whom the gen- 
eral physical condition is below normal. 

School work always intensifies the symp- 
toms and in all cases should be discontinued. 
The child must be taken away from com- 
panions who ridicule him if good results are to 
be obtained. Everything which tends to ir- 
ritate him should be eliminated and close at- 
tention should be given to his general health. 
Nearly all cases recover in a brief period 
if judicious treatment, with careful manage- 
ment, is carried out. 

HABIT SPASM 

Closely allied with chorea, and often con- 
fused with it, is the condition known as habit 



NERVOUS DISORDERS 161 

spasm. In it we find spasmodic movements 
of the muscles, usually of the face, which are 
confined to one group. These spasms are 
most commonly found to affect the muscles at 
the angle of the mouth, or those of the eye lids, 
though other groups are sometimes involved. 
At first the movements are scarcely percepti- 
ble, or may escape notice entirely. If per- 
sisted in they become more marked and occur 
with greater frequence. 

The child blinks or twists its face and con- 
tinues to do so even when reprimanded. 
Punishments never help, and often exaggerate 
the condition. The chiding of fellow pupils 
aggravates the symptoms and the condition 
progresses rapidly until the child is taken from 
school. In neglected cases the disease may 
become permanent and continues through life. 

The cause is often to be found in perverted 
general health associated with a neurosis or 
nervous temperament, either inherited or ac- 
quired. The object of the treatment in these 
cases is to remove the cause. The eyes should 



162 ADENOIDS AND KINDRED PERILS 

be examined for muscular errors, the nervous 
system should be built up by rest, appropriate 
food and sufficient sleep, and school work 
should be entirely suspended. 

HYSTERIA 

The exaggerated nervous irritability of over 
sensitive and overworked school children some- 
times manifests itself in what is generally 
known as hysteria, a term used to designate a 
great train of erratic symptoms of nervous 
origin. Many pages might be devoted to an 
enumeration of the different s} r mptoms which 
find their way into the classification of hys- 
teria. They range all the way from nervous 
headache to convulsions and profound cata- 
lepsy. Teachers have most to deal, however, 
with the class of children who are ultraemo- 
tional, who are easily moved to outbursts of 
either laughing or weeping, or to hysterical 
fainting, followed by more or less prolonged 
unconsciousness. These symptoms, even 
though mild in their nature, should be 



NERVOUS DISORDERS 163 

the cause of much solicitude, for from this 
class of nervous children are recruited the in- 
mates of our asylums late in life if proper at- 
tention is not given the condition at its onset. 

A hysterical fit is not attended with any im- 
mediate danger and seldom occurs when there 
is no one present to observe it. It may usually 
be recognized and distinguished from other 
spasms by a slight quivering of the lips and eye- 
lids, and a tendency to close the lids closely 
after they have been opened. The greatest 
danger is not immediate but remote. The 
symptoms indicate a disturbed mental equili- 
brium. A physician should at once regu- 
late the treatment and discipline of the child, 
which treatment will have in view the eradica- 
tion of predisposing causes. The future of 
these, more than any other class of children, 
depends upon proper management, and only 
by such judicious management will many a 
child be spared from becoming a resident of 
a hospital for the insane later in life. 

Hysteria, like other nervous diseases, is 



164 ADENOIDS AND KINDRED PERILS 

caused by destructive changes in the brain and 
the cause of these changes should be sought 
for and eliminated. In many cases the abnor- 
malities will be found dependent upon the evils 
of our modern artificial civilization. An at- 
tempt to squeeze the brain into the particular 
shape fashioned by a school curriculum often 
ends in an attack of hysteria. 

The term ' 'overpressure' ' at school seems to 
have been formed with the idea that a certain 
amount of pressure at school is indicated. 
This is all wrong. Education should be a 
natural process, children should be as well 
from a physical standpoint at the end of the 
term as they are at the beginning. If they are 
taught to observe the fundamental laws of 
health during the school year, if the education 
is carried on with a view to growth and not 
pressure, if the system is one of drawing out 
and not crowding in, the process is a natural 
one, and the various nervous disorders and 
physical disturbances will be eliminated. 



Chapter XII 
DEFECTIVE CHILDREN 



Chapter XII 
DEFECTIVE CHILDREN 

EVERY teacher has to contend with a 
class of children who, though not ex- 
hibiting signs of mental abnormality before 
school life is begun, remain more or less in- 
definitely in the lower grades and seem to de- 
rive little or no benefit from their class 
work. Many of these children are not mental 
defectives in the strict sense of the word, their 
inability to keep up with their classes being 
due to a defect of some of the special centers 
of the brain. 

A child goes to school at the age of six or 
seven with the centers of his brain governing 
the special senses, motion, speech, etc., fairly 
well developed. This comes to him naturally 
as an inheritance from an ancestry dating back 
to primitive man. To all appearances he is 

167 



168 ADENOIDS AND KINDRED PERILS 

at that time a normal child. From an educa- 
tional point of view, he may prove a defective 
child, however, even though he has hitherto ap- 
peared normal to his parents. 

It has been conclusively demonstrated that 
the centers in the brain which have most to do 
with a child's education are not a natural in- 
heritance and have to be built up by the child 
himself. This process of brain building is a 
slow one and in some children one or more 
centers refuse absolutely to develop and the 
child falls into the class of defectives. For 
instance, what is described by physiologists as 
the visual word or word seeing center refuses 
all stimulation and growth. In such a case 
the child sees the word plainly, but cannot 
distinguish it from other words. A defect in 
development of the auditory word center gives 
a confusion of spoken words. 

This brain law has been understood only 
during the last few years, but the conclusions 
of physiologists regarding it are definite. A 
lover of music of to-day may to-morrow, by 




SECTION OF BRAIN SHOWING SPECIAL CENTERS 



DEFECTIVE CHILDREN 171 

an injury to the center of his brain governing 
his musical faculty, recognize in a symphony 
nothing but a jargon of sounds, and an artist, 
by an affection of his object seeing center may 
see nothing in his picture but daubs of paint. 
In neither of these instances is the special 
sense of sound or sight defective, the special 
centers only being at fault. 

Injuries to the special centers in the brain 
are often due to cerebral hemorrhage. In 
numbers of cases localization of blood clots 
have been made by the effect produced upon 
special functions, the correctness of the local- 
ization being demonstrated by a trephining of 
the skull resulting in recovery. 

Under practical, individual instruction chil- 
dren, in whom an acuteness of any given cen- 
ter is lacking, by much attention given to build- 
ing these special centers, often make such im- 
provement that their defects are entirely over- 
come, and they regain the place in their classes. 

A more unfortunate class of children is to 
be found in those who, though not apparently 



in ADENOIDS AND KINDRED PERILS 

lacking in any one special center, seem not to 
respond to any mental stimulation whatever, 
all attempts at instruction in the ordinary class 
room seeming to be entirely wasted upon them. 
These children remain from year to year in 
the lower grades. The teacher becomes dis- 
couraged and they receive little or no atten- 
tion. These children, through hopeless com- 
petition, become as discouraged as do their 
teachers, and, unless rescued, are doomed to 
a life of uselessness and dependence. 

It is a great injustice to the mentally de- 
ficient young to allow them to remain in the 
ordinary class rooms. They should be trans- 
ferred to classes, where by careful and judi- 
cious teaching under the auspices of someone 
skilled in the work, they may be developed 
to a more or less extent and a fair amount of 
intellectual progress may be made. 



Chapter XIII 
OVER PRESSURE 



Chapter XIII 
OVER PRESSURE 

EDUCATION of the young is a process 
which has in view the fitting of the child 
for the battle of life. True education is a 
stimulation of physical and mental develop- 
ment, in which no one part of the body or 
mental faculty is developed at the expense of 
another. 

The pupil of to-day who develops his mind 
at the expense of his body, runs a great risk 
of being outstripped a little later on in the 
race of life by his fellows whose education has 
been wisely directed so that the healthy equi- 
librium between mind and body growth has 
been maintained. 

In true education the brain is to be trained 
and not crammed. The child should be led 
and not driven, should be gradually molded, 

175 



176 ADENOIDS AND KINDRED PERILS 

and not squeezed into that particular shape 
laid down in a given curriculum. In a ra- 
tional system of education, mental growth 
should not be considered aside from physical 
growth. If a balance between brain and 
muscle energy is not maintained, a certain 
amount of effete or used-up matter is kept in 
the body instead of being cast off, and this, 
sooner or later, acts as an impediment to 
proper brain work. While a child is in school 
it is more vitally important to look after its 
physical than its mental growth. A hindrance 
to the physical development of the pupil dur- 
ing its school life cannot be compensated for 
by any degree of mental accomplishment. 
During the years of school life, a child is either 
building up a good physique as it develops its 
brain or is paving the way by badly directed 
efforts to digestive, nervous and circulatory 
disturbances. 

A close observer will notice that a child does 
its best work after a period of rest, that better 
results are accomplished early in the morning 



OVER PRESSURE 177 

and that the long drawn out home lessons are 
not only badly assimilated, but that this un- 
natural pressure of work more or less unfits 
it for the tasks of the following day. The 
requirement of such home lessons for young 
children is bad if the child's welfare is to be 
considered. During the day his mind has 
been applied more or less closely and a change 
of thought is essential to the healthy develop- 
ment of his brain power. Intense applica- 
tion uses up what may be termed his reserve 
nerve force. When this nervous reserve is 
interfered with he becomes pale, irritable and 
fidgety, has bad digestion and, if the cause is 
not removed, takes his first step upon the road 
which leads to neurasthenia and ill health in 
later years. 

Brain tissue requires rest just as muscle 
tissue does. Toxins, the result of mental ex- 
ercise, are developed in the brain during its 
periods of activity, and when they accumulate 
beyond a certain point no further mental work 
is possible. Mental fatigue in children, if not 



178 ADENOIDS AND KINDRED PERILS 

properly relieved by diversion, rest and sleep, 
lays the foundation for future nervous and 
physical calamities. After the day's work at 
school is over, the evenings should be devoted 
toward building up this nervous reserve force 
and eliminating the brain toxins by rest, re- 
laxation and play. 

All authorities now agree that the education 
of a child should not commence too early, and 
when it begins it should be carried on with 
his physical welfare first to be considered. 
The school hours should be broken up into 
periods of instruction and relaxation, and the 
more systematic and pleasing the relaxation 
the more receptive will be the pupil's mind to 
instruction. If parents and teachers would 
keep in mind that over application is injurious 
to bodily strength, and that bodily strength 
controls mental growth, that education which 
interferes with the perfect development of 
manhood or that develops a girl's mind at the 
expense of her fitness for motherhood is the 



OVER PRESSURE 179 

worst form of excess, a great step toward 
human progress would be made. 

Usually the first symptom of an untoward 
nature which appears in the overworked child 
is nervousness. This is most apt to occur in 
precocious, bright, energetic children. It 
should receive the immediate attention of par- 
ents and teachers, and be carefully treated by 
appropriate relaxation if the child is to be 
rescued from a life of uselessness for which his 
elders will be to blame. Nervous, overworked 
children are irritable, easily excited, they spend 
their nights in fretful slumber and toss rest- 
lessly about in bed. 

Peaceful sleep is as necessary to the human 
body as food. Brain repair goes on at its best 
during the hours of sleep and only when the 
mind is dormant is complete rest established. 
Long hours for sleep are more important in 
children than in adults. Brain growth is go- 
ing on and nature seems to require more time 
for brain renovation. During our waking 
hours something which may be termed brain 



180 ADENOIDS AND KINDRED PERILS 

waste is stored up within us, and if not elimi- 
nated by sleep, kills us or drives us insane. 
During sleep both body and brain are in com- 
plete rest. If a sleeping child's hand is raised, 
it falls as if lifeless. No energy is being ex- 
pended. The brain currents are at rest. Na- 
ture is at work throwing out the waste and 
building up the cells used up the previous day. 

When a child is nervous and does not sleep, 
he grows pale and wan, develops headache, 
wears a strange frowning expression and ac- 
quires an unhealthy appearance generally. 
When these symptoms arise a long rest from 
mental application, with appropriate exercise 
and much time in the open air, is absolutely 
required. If the pressure at school is con- 
tinued after these symptoms appear, and if 
illy advised methods of correction are in- 
stituted, there is danger of driving the child 
into a physical and mental breakdown with 
promise of lifelong misery and suffering. 

To avoid the disastrous effects of overwork 
seen in some children, the teacher should study 



OVER PRESSURE 181 

closely the temperament of each child. A close 
observation of the actions and sayings of the 
different children should regulate the basis 
of their instruction. The precocious children 
should be held back rather than crowded. 
Precocity may mean a lack of mental equi- 
librium. Excitement and irritation of the 
brain may be the cause of a temporary ability 
to learn readily. Actual brain disease is often 
preceded by a period of exceptional acuteness 
of the intellect. This has been observed to a 
marked degree in persons developing paresis, 
but this acuteness is soon followed by dullness 
and delusions. 

The routine of school work should be uni- 
form. From a physical standpoint it would 
be better that the classes should undergo ex- 
aminations at frequent intervals rather than 
have the supreme test preceded by the nerve 
racking process of "cramming" made at the 
end of the session. Pupils who absorb knowl- 
edge in this way rarely retain it and the great 
expenditure of nerve force occasioned by this 



182 ADENOIDS AND KINDRED PERILS 

"system" of learning often results in perma- 
nent injury. 

Competition is wholesome but it should last 
throughout the year and should not be used 
to stimulate a pupil to do the greater part of 
a year's work in a month. 

Overwork in schools could be largely 
avoided by good classification, regular but 
brief periods of study with frequent intermis- 
sions for exercise. In this way there would 
be no unequal development between brain and 
body and a solid foundation for a building up 
of the special faculties would be laid. 



Chapter XIV 

EFFECTS OF POOR VENTI- 
LATION 



Chapter XIV 

EFFECTS OF POOR VENTI- 
LATION 

f I THE health of school children is influenced 
-*• to a great degree by the character of ven- 
tilation in the school room. Impurities of the 
atmosphere may be responsible for a great 
many cases of illness, and good grades in classes 
can not be expected in rooms where the at- 
mosphere is loaded with poisonous gases. 
Impurities of the air in the class room may be 
due to various forms of contamination, the 
most common of which is derived from the 
pupils themselves by the process of respiration. 
The effect of vitiated air containing organic 
matter from the body, together with gases pro- 
duced by respiration, is headache, sluggish- 

185 



186 ADENOIDS AND KINDRED PERILS 

ness and occasional attacks of faintness. 
Children spending much time in such an at- 
mosphere become pale, lose appetite and are 
subject to depression of spirits and general 
inertness. Such children, besides losing their 
normal resistance to disease, develop an in- 
ability to concentrate the attention, and study 
becomes a burden. With these facts in mind 
it becomes obvious that ventilation in the 
school must be good, and the rooms must not 
be overcrowded if its occupants are not to 
suffer both mental and physical deterioration. 
As already noted, the atmosphere of an oc- 
cupied room contains a great number of harm- 
ful vapors and gases, and in them germ life 
abounds and thrives in proportion to its con- 
tamination. Dust is always present and acts 
as carriers of microbes, thus assisting in the 
spread of disease. It is permeated with ex- 
haled air which has been robbed of its oxygen 
and loaded with carbon-dioxide. It is also 
saturated with water vapor from the lungs 
containing many organic impurities. This 



EFFECTS OF POOR VENTILATION 187 

water vapor decreases the normal evaporation 
of moisture from the surface of the body, 
thereby causing much discomfort. The writer 
must say in all candor that he has seldom gone 
into a school in this country during working 
hours, especially in winter, without finding 
present to a marked degree, atmospheric con- 
tamination, for which overcrowding and in- 
sufficient ventilation are directly responsible. 
To condemn children to breathe such air as 
this for several hours each day is to subject 
them to a destruction of their vitality and a 
tendency to the acquirement of all forms of 
disease. A child in whom there is an inherited 
predisposition toward tuberculosis, for in- 
stance, who is compelled to breathe a vitiated 
atmosphere, is apt to develop active symptoms 
of the disease in a few weeks or months, and 
to transmit the infection to others about him. 
Of all the vital questions to be considered in 
the school room that of clean air is by far the 
most important, because it deals directly with 
the health and the lives of the pupils. 



188 ADENOIDS AND KINDRED PERILS 

The following table shows the composition 
of fresh air: 

Nitrogen 79. 

Oxygen .20.96 

Carbon-dioxide 04 



100.00 
Air that has been exhaled from the lungs 
contains : 

Nitrogen 79. 

Oxygen 16. 

Carbon-dioxide 4. 

Organic matter 1. 



100.00 
This table shows that in expired air the 
amount of oxygen is diminished and that car- 
bon-dioxide is greatly increased, besides one 
per cent, of its composition is made up of 
harmful organic matter, which nature has 
thrown off from the body. 

The most injurious of all the impurities to 
be found in exhaled air is carbon-dioxide. It 
is this gas that sometimes causes death to per- 



EFFECTS OF POOR VENTILATION 189 

sons who are confined in badly ventilated 
rooms. Six fatalities occurred recently in a 
penal institution of this country, which were 
directly traceable to self -poisoning from this 
source. In the famous Black Hole of Calcutta 
one hundred and twenty-three out of one hun- 
dred and forty-six persons met their death in 
one night from carbon-dioxide poisoning. 
Several similar catastrophes have befallen per- 
sons who have been confined in rooms with 
little or no ventilation. 

Though carbon-dioxide contamination is 
never so profound as to cause death in the 
school room, these cases are mentioned to il- 
lustrate that, with poor ventilation we have 
to contend with a pollution of the air of a 
more or less dangerous degree. It is esti- 
mated that the average child of twelve years 
produces six feet of carbon-dioxide per hour 
by the process of respiration. With this in 
mind it is very evident that the occupants of 
a school room will deteriorate the atmosphere 
in a brief space of time unless the room is pro- 



190 ADENOIDS AND KINDRED PERILS 

vided with the proper facilities for systematic 
ventilation. 

Organic impurities in the air, due to respira- 
tion, consist principally of dead epithelium, 
which is a favorable soil for all forms of bac- 
terial life. Emanations are also given off 
from the skin, and among poorly cared for 
children, decomposition of organic matter on 
the clothing is a factor in vitiating the atmos- 
phere in the school room. Gases escaping 
from defects in plumbing are dangerous be- 
cause of their poisonous character and of the 
injurious micro-organisms which they contain. 
The problems of artificial heating are also to 
be reckoned with. Combustion of coal liber- 
ates carbon-dioxide, besides sulphides of car- 
bon and ammonia and other compounds of sul- 
phur, all of which are deleterious in the ex- 
treme. 

Pure air is as necessary to life as pure food, 
and this fact makes the problem of ventilation 
a paramount one. In small schools in the 
country and in the older schools in the city, 



EFFECTS OF POOR VENTILATION 191 

the question of providing the pupils with fresh 
air seems never to have been considered in 
any way, and some of the elaborate apparatus 
in the modern schools seem as inefficient as 
they are complicated. School authorities in 
selecting plans for school buildings rarely 
give attention to the provision of adequate 
floor space for the pupils. Nearly all of our 
schools are overcrowded and this close proxim- 
ity of the pupils makes good ventilation im- 
possible. 

The first evil to be noticed in overcrowding 
is an elevation of the temperature of the 
room. The natural heat of the body is 98.6 
and when overcrowding of the room occurs, 
the temperature of the air, by contact with 
the persons of its occupants, rapidly rises. 
The warmth of the atmosphere in the room 
will create draughts near the inlets for air 
and those sitting near them will be chilled. 
When the temperature without is colder than 
within, these draughts of cold air are com- 
plained of, the inlets are closed and the process 



192 ADENOIDS AND KINDRED PERILS 

of contamination is increased. Sandwiching 
children as is done in some of our American 
schools is responsible for the persistent colds 
which attend many of them during the ses- 
sion and for the general physical perversion 
which others of them undergo. The Privy- 
council of London will not allow a school to 
have an annual grant which does not provide 
eight square feet of floor space for each pupil. 
This allowance does not cover wasted space. 
The institution of a similar rule in our schools, 
if adhered to, would prevent much physical 
injury and discomfort to our rising genera- 
tion. 

It is to be admitted that the air of all oc- 
cupied rooms must necessarily be more or less 
polluted and the rule should be to supply 
enough fresh air to keep the impurities min- 
imized so that they do not interfere with 
health. There must be provisions for free 
admission of fresh air and adequate openings 
for the escape of used up air. Two thousand 
feet of fresh air is required every hour for 



EFFECTS OF POOR VENTILATION 193 

each pupil in a room (Rolley's Hygiene), and 
in order to provide this there should be an 
opening of sixteen square inches per pupil, 
assuming that the air enters the room at a 
velocity of five feet a second. An outlet of 
the same size is necessary. In a class room 
containing forty-eight pupils there should be, 
therefore, an opening of five and one-third 
feet for the admission of air and one of similar 
size for its exit. 

It is not within the scope of this little vol- 
ume to enter into the principles of the various 
methods employed in ventilation. This chap- 
ter will do no more than call attention to the 
importance of ventilation, and as this is a sub- 
ject that has been so generally neglected in 
the schools, no excuse is necessary for its in- 
troduction here. 



Chapter XV 
INSUFFICIENT EXERCISE 



Chapter XV 
INSUFFICIENT EXERCISE 

IN order to overcome the evil physical re- 
sults of school life a certain amount of ex- 
ercise is indispensable. The development of 
the mind at the expense of the body is wrong, 
and children who grow to manhood or 
womanhood with this very important feature 
of their education neglected, often find them- 
selves badly handicapped in the great battle 
of life. 

Exercise by equalizing the action of the 
muscles, overcomes the tendency toward de- 
formities occasioned by work in the class 
room. Muscles which remain a long time in- 
active lose their power of concentration and 
fail to perform the harmonious movements 
which give grace to the frame. 

A child growing up without the proper 

19T 



198 ADENOIDS AND KINDRED PERILS 

amount of exercise, becomes awkward and un- 
gainly and is unable to perform the acts re- 
quiring muscular dexterity. 

Mind and muscle should be developed 
simultaneously. Exercise keeps the muscles 
in a healthy condition and under its influence 
they retain the power to act in direct influ- 
ence to the will. Trained muscles act in co- 
ordination, relieving all expenditure of nerv- 
ous energy. They may be said to act auto- 
matically. This is forcibly illustrated in the 
trained athlete who can perform certain feats, 
such as running long stretches, with less ex- 
penditure of energy than would be occasioned 
by the novice in making one half the distance. 

Taking active parts in out-of-door sports 
teaches the child to see quickly and to act 
quickly. It increases his self-control and 
stimulates his judgment. Games bring about 
a certain relaxation which offsets the neces- 
sary but physically deteriorating effects of the 
restraint and rigidity of the class room. 
They quicken the respiration and increased 



INSUFFICIENT EXERCISE 199 

amounts of oxygen are thereby thrown into 
the lungs, and without this life giver the build- 
ing of the muscles, nerve and bone, would not 
be accomplished. This increased breathing 
develops the thorax, gives its muscles tone and 
produces a permanent expansion of the lungs. 

Exercise equalizes and quickens the circula- 
tion of the blood. In the class room where the 
brain is active, there is an increased flow of 
blood to the brain. The blood gravitates to 
the extremities and abdomen when it is not 
needed and a stasis of the circulation is thereby 
brought about, but when the action of the 
heart is increased by judicious exercise a re- 
distribution of the blood to its proper places 
results. All evidence of congestion disap- 
pears and the spirits become jubilant and 
lively. 

Supervision of school games is necessary, 
for without it the timid or weakly children are 
apt to be pushed out entirely. Teachers 
should avoid, however, making games stilted. 
The children's voices should not be restrained 



200 ADENOIDS AND KINDRED PERILS 

and everything tending to abate their natural 
buoyancy should be avoided. 

It would be a capital idea for every school 
to devote a brief period each day to regulated 
physical exercise, though this should never be 
done to the exclusion of out-door sports. Ex- 
ercise given small children should be free from 
difficult or complicated movements, but should 
be limited to simple methods of developing the 
chest and increasing the respiratory process. 
As the child advances in age this exercise may, 
with impunity, be made more exacting. 



Chapter XVI 
TUBERCULOSIS 



Chapter XVI 
TUBERCULOSIS 

TUBERCULOSIS may be termed a dis- 
ease of civilization. When Columbus 
discovered America, it was unknown among 
the natives whose lives from remote ages had 
been spent in the open air. The civilization 
which we have forced upon the Indian has 
been dearly paid for, for at the present the 
per cent, of tuberculosis cases is much higher 
among the Indian people than it is among the 
Whites. Indeed it is one of the potent fac- 
tors which is gradually leading to their ex- 
termination. 

The havoc being wrought by this insidious 
and disastrous disease is alarming. Despite 
the discoveries relative to the cause of infec- 
tion, and the best manner of combating its 
spread, it is steadily on the increase. It is by 

203 



204 ADENOIDS AND KINDRED PERILS 

far the most common cause of death in this 
country. Our statistics show us that fifteen out 
of every hundred people succumb to its rav- 
ages. By incapacitating those affected with 
it from making a livelihood, it is the cause of a 
large per cent, of the country's pauperism. 
The amount of money spent each year in sup- 
porting its unfortunate victims is truly enor- 
mous and the wages lost by those afflicted is 
beyond the range of anything like adequate 
calculation. 

It is now an established fact that the dis- 
ease is caused by a special form of micro-or- 
ganism called the tubercle bacillus. This 
germ may enter the body and attack any part 
of it. No bodily structure seems to have the 
power of establishing an immunity against its 
invasion. It may attack the skin and cause 
a slow but permanently disfiguring deformity. 
Its ravages upon the glandular system are 
even more serious and bones and joints, es- 
pecially in children, succumb readily to it. 
The most frequent site of its attack is the lungs 



TUBERCULOSIS 205 

and there it evidences itself in what is gener- 
ally known as consumption. The intestines 
frequently suffer from its encroachments and 
even the brain is often affected, for tubercular 
meningitis every year gives us a very high 
mortality. 

As has been stated, the determining cause 
of the disease is the tubercle bacillus. This or- 
ganism has a great vitality when left in dust 
and dirt hid away from the light, but it suc- 
cumbs almost immediately when exposed to 
the direct rays of the sun. Its spread is due 
to the promiscuous habit of spitting more than 
to any other cause. Unfortunately many 
consumptives through ignorance or because 
of a contempt for the welfare of others, spit 
about in a most reckless manner. The sputum 
lodges in the dust and when dry is blown 
about and, being inhaled by the passerby, 
finds lodgment in his throat and lungs. 

Post-mortem examinations show that a 
larger per cent, of persons than was previously 
supposed, have been infected with tuber- 



206 ADENOIDS AND KINDRED PERILS 

culosis, for the lungs examined in thousands 
of cases where death ensued from other causes, 
have shown healed up patches. This was evi- 
dence that the tubercle bacillus had at one time 
attacked these parts and had been eventually 
exterminated by nature. This was a hopeful 
discovery as it proved that, even when one is 
infected, increased bodily resistance, brought 
about by correct living, may defeat and ex- 
terminate the disease. 

The popular idea that tuberculosis is in- 
herited is a fallacious one. While in some 
families it may be noted that their history 
shows a number of cases of tuberculosis, it is 
now understood that heredity can only convey 
a predisposition toward the disease. In fam- 
ilies where the mortality is high the explana- 
tion is, that conditions common to the family 
have produced the infection in its different 
members. 

The inherited predisposition toward tuber- 
culosis may be aggravated by a decreased 
vitality in the child brought about by condi- 



TUBERCULOSIS 207 

tions such as measles and la grippe and other 
diseases of a debilitating nature. Injudicious 
feeding is a potent factor in stimulating the 
inherited tendency toward infection. It has 
been observed that bottle fed babies are more 
liable to infection later in life than those who 
have been breast fed because of the decreased 
vitality and weakened resisting power that 
these children acquire. And here we beg to 
say with no more candor than pity that the 
mother who willfully shirks her maternal re- 
sponsibility, takes her infant from the breast 
and substitutes for its nourishment any of the 
artificial foods, is guilty of an act little short 
of criminal. 

Badly kept dusty streets and dust gen- 
erally, predispose to tuberculosis because 
through this medium the bacillus is most often 
conveyed to the lungs. City streets should be 
sprinkled before being cleaned, and the sweep- 
ing should be done after midnight instead of 
in the evening, the time selected by most of 
our civic authorities, who often seem more de- 



808 ADENOIDS AND KINDRED PERILS 

voted to their own convenience than to the 
conservation of the public health. 

In schools the floors should be lightly 
sprinkled and the rooms be cleared of all oc- 
cupants during the process of sweeping. 
The vacuum cleaner, which now seems almost 
perfected, is an appliance which we hope to 
soon see in general use, as it draws the dust 
into a receptacle instead of scattering it about 
where it settles only to be redistributed at the 
next sweeping. 

The way to consumption is often paved by 
bad ventilation in the home and school. Par- 
ents are prone to give too little attention to 
the proper air supply in the sleeping rooms of 
their children. The air of all occupied rooms 
is necessarily more impure than external air. 
Emanations are constantly arising from the 
body and the exhaled air is laden with carbon- 
dioxide, a gas which when concentrated, is 
sufficiently poisonous to cause death. Perfect 
ventilation in sleeping rooms is not easily ac- 
complished, and for this reason it would be 



TUBERCULOSIS 209 

better for us all if we would sleep out of doors. 
When this is not possible the supply of fresh 
air should be kept up by appropriate open- 
ings, so that an observant person on entering 
the room from the outside will not be able to 
detect the slightest degree of "stuffiness." 
In the school room the sensation of "closeness" 
is often perceptible to anyone who is a lover 
of fresh air. Badly ventilated schools are a 
menace to the health of its pupils. A lower- 
ing of the vitality of its occupants results, 
their nutrition is impaired and with bad nutri- 
tion comes decreased resistance toward infec- 
tion, all of which are potent factors in abet- 
ting the latent predisposition toward tuber- 
culosis. 

The hackneyed adage, "An ounce of pre- 
vention is worth a pound of cure," applies to 
this disease more than to any other, for pre- 
vention here involves a wider range than the 
destruction of the germ. General cleanli- 
ness, proper attention to infant feeding and 
the education of the masses in hygiene and 



210 ADENOIDS AND KINDRED PERILS 

sanitation are matters of vital importance in 
controlling the spread of tuberculosis. 

Public buildings, churches, schools and 
other places where people congregate must be 
kept cleaner, better ventilated and freer from 
dust. The question of milk, that great con- 
veyor of infection, must receive more atten- 
tion from the proper authorities. If food for 
the young would be made plainer and of a 
more nourishing character, if the tidbits and 
digestion disturbers would be eliminated, the 
child would have a better start in life and 
would be more thoroughly prepared to with- 
stand the encroachments of disease. Children 
known to be tubercular, should not be ad- 
mitted to schools. Spitting ordinances should 
exist in all cities, and should be vigorously en- 
forced, and a general campaign of education 
should not only be begun but should never 
cease. These fundamental laws of hygiene 
should form a part of the child's training at 
school and in this way they would be carried 
indirectly into the homes. 



TUBERCULOSIS 211 

Children should understand the impor- 
tance of fresh air and of exercise, the necessity 
of cleanliness, and the danger of spitting 
should be impressed upon them. Persons who 
are infected with the disease should protect 
the health of others by carefully depositing 
their sputa into vessels containing disinfect- 
ants or into cloths that can be burned. If 
these precautions are disregarded, the health 
authorities should enforce the spitting ordi- 
nance. One of the points to be impressed upon 
the mind of the public is that one consumptive, 
if careless, may be the cause of infecting many 
healthy persons. If the dangers of promiscu- 
ous spitting were thoroughly understood, 
every careless expectorator would be hailed 
with so much indignation that the habit would 
cease and the public health would thereby be 
conserved. 

School rooms should be regarded as places 
which are apt to spread infection, particularly 
that of tuberculosis. Many of the schools in 
this country have never been properly cleaned 



212 ADENOIDS AND KINDRED PERILS 

since they were built. A thorough disinfec- 
tion of every room where children congregate 
should be made monthly or more often. Dis- 
infectants scattered about the room will not 
suffice, for if they are not made strong enough 
to kill the occupants of the room, they will 
certainly have no effect upon the germ life in 
existence there. Deodorants are absolutely 
of no value, as masking an odor only makes 
one unconscious of its presence and gives a 
false security. 

A bichloride of mercury solution 1/10000 
is the most efficient disinfectant for floors and 
furniture. It is cheap, does not injure the 
hands and has no bad effect upon paint, wood 
or glass. Floors and walls should be scrubbed 
and desks and seats should be washed with this 
solution. Then the room should be closed and 
disinfected with formaldehyde gas or sulphur 
should be burned in it. If this is properly 
done the room, when opened, is entirely free 
from bacterial life and the danger of infection 
is nil. 



TUBERCULOSIS 213 

While some of the measures mentioned 
here may require a little time and trouble and 
the expenditure of some money, if they are 
carried out it will be time and money well in- 
vested. A much better and more economical 
plan would be to safeguard the health of the 
children, rather than to take care of them after 
they become infected. Half of the money 
spent on tubercular hospitals in this country 
every year would cleanse all the schools in 
America. The prevention, by adequate 
means, of the terrible sacrifice of human life 
from this great white plague should be the am- 
bition of every community, and this ambition 
can be directed in proper channels only by the 
education of the public in reference to the im- 
portance of correct living, sanitation and 
hygiene. 



Chapter XVII 
EPIDEMIC DISEASES 



Chapter XVII 
EPIDEMIC DISEASES 

ONE of the most important subjects, 
which has reference to the health of 
school children, is that which deals with pre- 
vention of the spread of epidemic diseases. 
An ordinary amount of precaution and intelli- 
gent observation on the part of the teacher 
will do much to prevent a single case of con- 
tagious disease from causing a school epidemic 
and possibly a general epidemic. Some of 
these diseases are only mildly contagious at 
the onset and a casual knowledge by the 
teacher of the prodromal symptoms mani- 
fested in each disease may be the means of 
preventing a general outbreak in the school, 
which would necessitate it being closed indefi- 
nitely. 

A great many lives have been lost and un- 

217 



218 ADENOIDS AND KINDRED PERILS 

told miseries have resulted from a lack of this 
knowledge regarding the diseases which are 
likely to become epidemic. Measles, small 
pox, diphtheria, mumps, chicken pox, whoop- 
ing cough, scarlet fever, etc., have certain 
easily recognized characteristics the detection 
of which in the school room is of the utmost 
importance to both teacher and pupils. 
These diseases are nearly all communicable 
through the air. In most of them, however, 
the distance required for infection is small, 
and only in one or two diseases mentioned, such 
as small pox or scarlet fever, can the infection 
be carried any considerable distance. 

Every child who is suspected of having an 
infectious disease should be sent home immedi- 
ately and in most cases, when the diagnosis is 
established, should be put under quarantine. 
Those who have been nearest to him, or who 
have been immediately associated with him, 
should also be excluded and kept under obser- 
vation until the period of incubation or the 
time necessary to develop the disease, has past. 



EPIDEMIC DISEASES 219 

Under no circumstances should a member of 
the same family be admitted to the school. In 
all cases the room in which the disease has 
been found should be closed sufficiently long 
for its complete fumigation. Desks, floors 
and walls should be disinfected, and books, 
pencils and other simple paraphernalia used 
by the pupil should be burned. The infected 
child should not resume attendance after its 
recovery until a certificate from the attending 
physician is produced, stating that the danger 
from infection is passed. 

A noticeable characteristic in these epidemic 
diseases is that one attack prevents a recur- 
rence of the disease in the same individual. 
In this respect nature is kind, and provides in 
the blood a principle which confers immunity 
throughout life. Diphtheria presents an ex- 
ample of the principal exception to this rule. 

Epidemic diseases are always characterized 
by fever more or less pronounced, due to tis- 
sue change and general disturbance of bodily 
function. These elevations of temperature 



220 ADENOIDS AND KINDRED PERILS 

are spoken of as essential fevers, a term dis- 
tinguishing them from the general rise of 
temperature to be found in chronic disease or 
following wounds or injuries. This type of 
temperature rise is known as symptomatic 
fever. An elevation of temperature in a puny 
child, who is known to suffer from some of the 
chronic ailments of childhood may not be 
viewed with alarm as far as school welfare is 
concerned ; however, in one of robust tempera- 
ment a manifestation of fever should at once 
awaken solicitude, and in all cases it is ex- 
pedient that the cause be investigated at once. 
The essential fevers owe their origin to a 
specific organism or germ. These germs are 
derived from cases of a similar nature and find 
access to the body by being inhaled into the 
lungs, or they may enter the mouth through 
the mediums of drinking cups, the fingers, 
kissing, etc. They may also be carried into 
the alimentary tract by food and drink. 
Finding in the body suitable nutriment for 
their existence they multiply enormously, and 



EPIDEMIC DISEASES 221 

a process of invasion begins with the general 
disturbances in each disease. Of these dis- 
turbances the first to be noticed is fever, and 
as this often presents itself before the child 
can transmit the disease to others, it should 
be watched for closely in the school room. 

Many teachers who have the welfare of their 
pupils at heart, now have clinical thermome- 
ters. It would be well if all schools were pro- 
vided with them. The object of the clinical 
thermometer is to estimate internal heat, and 
it should be placed when used so that the tis- 
sues completely surround the bulb. In the 
school room the positions most available are 
the mouth, and arm pit. If the arm pit is 
selected it should first be dried, otherwise a 
correct register will not be obtained. The 
bulb should be placed deep in the hollow of 
the arm and the arm pressed closely upon it. 
In all but nervous or refractory children the 
mouth is the most suitable location. The in- 
strument must be placed well under the 
tongue and the lips should be held firmly to- 



222 ADENOIDS AND KINDRED PERILS 

gether while the child breathes through the 
nose. 

The human body has a temperature which 
varies only slightly in health and is not af- 
fected by either season or climate. This is 
spoken of as the normal temperature and is 
about 98^° Fahrenheit. Very active exer- 
cise will elevate it a fraction of a degree, after 
which from exhaustion it may fall slightly be- 
low normal. In very young children, and 
after a full meal, it is often found to be slightly 
above what is known as normal, but this does 
not indicate an unhealthy disturbance. 

Associated with temperature elevations 
marking the onset of contagious diseases are 
certain manifestations which are more or less 
constant. Among these headache is the most 
predominant. This is nearly always one of 
the earliest symptoms of epidemic fevers. It 
is usually the most pronounced at the begin- 
ning of the attack and abates or entirely dis- 
appears after the first few days of the disease. 

The patients in the early stages of an acute 



EPIDEMIC DISEASES 223 

infectious disease may also be affected with 
vertigo or dizziness. They are likely to com- 
plain also of pains in the back or limbs, or a 
general soreness of the body or extremities. 
Not infrequently they complain of chilliness 
of the body and they may suddenly develop 
the most violent rigors. These are accom- 
panied by a coldness of the surface of the skin 
and a rise of the internal temperature. The 
lips and finger tips may take on a bluish 
color, the face become pale, and the teeth chat- 
ter violently and a general aspect of distress 
is manifested. There may also be impair- 
ment of the mental faculties, ranging all the 
way from a dull stupor, to the wild delirium 
which immediately sets the school room into 

a frenzv of excitement. 

%> 

The eyes often have a bright watery appear- 
ance with reddened lid margins. Deafness, 
especially at the advent of scarlet fever, is a 
common symptom and may be accompanied 
by great pain in the ear. Nose bleed occurs 
most frequently at the beginning of typhoid 



224 ADENOIDS AND KINDRED PERILS 

fever. Vomiting is not an infrequent symp- 
tom. The breathing of the child is apt to be 
hurried, though it may be irregular or jerky. 
Cough is often present at the beginning of 
measles and typhoid. The skin, after the chill 
passes, is bright or flushed. This scarlet color 
disappears under pressure of the fingers and 
leaves a white spot which fades away slowly. 

Eruptions of the skin are common in epi- 
demic diseases. The character of these erup- 
tions varies greatly and it is not to be sup- 
posed that they can be differentiated by the 
teacher. These suggestions are made, not 
with the view of having the teacher assume the 
mission of the physician, but to emphasize the 
importance of careful observation in the school 
room. Upon the acuteness of this observa- 
tion will the welfare of many children depend. 
Should this be accomplished, the purpose of 
the chapter will have been fully achieved. 

THE END 



